Techniques in endourology - Ureteroscopic approach to upper-tract urothelial tumors

Transitional-cell carcinoma (TCC) of the upper urinary tract has traditiona lly been managed by nephroureterectomy, whereas nephron-sparing surgery has been reserved for those few patients with solitary kidneys or bilateral le sions. However, with the introduction of improved diagnostic and therapeuti c technology, including smaller ureteroscopes and working instruments, and the concomitant ease of surveillance, ureteroscopic treatment of upper-trac t urothelial tumors has become a reasonable alternative to open operative i ntervention in patients requiring conservative management. Furthermore, as preoperative grading and staging have improved, ureteroscopic treatment of upper-tract urothelial tumors is assuming an increasingly important role in the management of some patients who might have otherwise been treated with a nephroureterectomy. The technique of ureteroscopic resection is describe d in detail.