Primary tumours of the upper urinary tract: a report on 15 cases.

Tumours of the upper urinary tract are rare, and in 30% of cases are multif ocal. They are of particular interest due to their difficulty of diagnosis. Regarding the diagnostic means involved, a relative contribution is provid ed by echography, CT-scan and magnetic resonance imaging; but the following approaches are of more significant value: i.v, urography, urethropyelograp hy, and especially endo-urologic investigation. However, it should be noted that uncertainty still remains concerning conservative treatment procedure s. In this study, we have reported on 15 cases of tumours of the upper urin ary tract, treated over a 10-year period, The patient population consisted of 12 men (80%) and three women (20%), with a mean age of 56 years (age ran ge 35 to 72 years). The clinical symptomatology was dominated by hematuria in 66%, pain in 53%, and urinary infection in 13% of cases. Pyelocaliceal t umours were the most frequent finding (66%); multifocality was observed in three patients (20%), IVP carried out in all patients permitted a certain d iagnosis to be obtained in 73% of cases. Echography and CT-scan were perfor med in the event of uncertain diagnosis. Cystoscopy revealed an associated tumour of the bladder in three cases. Nephro-ureterectomy with ablation of the collar of the bladder was performed in all patients. This intervention included double access (lumbar and iliac) in 86% of cases. The postoperativ e follow-up was marked by one recurrence of tumour of the controlateral upp er urinary tract eight months post-surgery. This tumour was treated by endo scopic resection. Regarding these observations and with a review of the literature, the autho rs have analysed the epidemiological, pathological and therapeutic aspects of this disease. (C) 2000 Editions scientifiques et medicales Elsevier SAS.