URETEROSCOPIC TREATMENT AND SURVEILLANCE OF UPPER URINARY-TRACT TRANSITIONAL-CELL CARCINOMA

Purpose: We determined the efficacy of ureteroscopic treatment of uppe r urinary tract transitional cell carcinoma. Materials and Methods: Of 92 patients diagnosed with upper urinary tract transitional cell carc inoma at our institution from 1985 to 1995, 38 (41 kidneys) underwent ureteroscopic treatment and followup. Semirigid and flexible ureterosc opes were used to examine the collecting system. Tumors were biopsied, and treated with fulguration, the neodymium:YAG laser and/or the holm ium:YAG laser. Patients were treated every 6 to 12 weeks until tumor-f ree and then followed on a strict endoscopic protocol. Results: Mean a nd median followup was 35.1 and 26 months, respectively (range 3 to 11 6). Grading of ureteroscopic biopsies was possible in 40 of 41 cases. Initial grading of tumors was low (grade 1 or 1 to 2) in 21 kidneys, g rade 2 in 14 and grade 3 in 5. Of 41 kidneys 28 (68%) were documented as tumor-free ureteroscopically at some time following treatment, incl uding 8 (29%) with subsequent recurrences that were treated endoscopic ally and 24 (86%) with no evidence of disease at the most recent follo wup. No patient to date has had progression of disease during endoscop ic followup. High tumor grade, size and multifocality were significant ly associated with tumor persistence and recurrence. Location in the k idney versus ureter was not a significant prognostic factor. Of the re current tumors 75% were not identified radiographically but were only discovered endoscopically. Two of 8 kidneys removed after endoscopic t reatment had no tumor stage (pTO). Conclusions: Endoscopic treatment o f upper urinary tract transitional, cell carcinoma is a reasonable met hod to treat carefully select patients based on strict indications. Co mplete endoscopic followup at regular intervals is essential to rule o ut recurrences.