Transitional-cell carcinoma of the renal pelvis: Ureteroscopic and percutaneous approach

There are a variety of publications advocating the ureteroscopic or the per cutaneous approach for the treatment of transitional cell carcinoma of the renal pelvis, The diagnostic tool of choice for the upper urinary tract and collecting system is the flexible ureteroscope, One of the major concerns about ureteroscopic management of renal disease initially was the lack of f lexibility of the instruments and therefore the inability to deal with dema nding sites. The advent of new ureteroscopic techniques, as well as the con tinuous evolution of the technology, have paved the way for safe and effect ive access to the upper urinary tract, In the hands of an experienced urolo gist, such procedures can provide reliable treatment options for small uppe r urinary tract lesions. Coupling minimal morbidity with ever-improving opt ics and flexibility, the ureteroscope of today leaves no area of the urinar y tract unseen. In patients with bulky tumors or in whom easy access and re section is not possible ureteroscopically, the percutaneous approach to the renal pelvis, although more invasive, provides a better working environmen t. Clearly, the most difficult aspect of ureteroscopic access to the lower pole is not just visibility but the loss of deflection caused by passage of various instruments through the working channel. Direct access via percuta neous approach with a large resectoscope avoids these problems.