Endourologic management of patients with upper-tract transitional-cell carcinoma: Long-term follow-up in a single center

Purpose: To evaluate the outcome of endoscopic management of upper-tract transitional-cell carcinoma (TCC). Patients and Methods: From March 1991 to March 2006, 40 patients with upper-tract TCC were treated by an endoscopic approach as the primary management: 37 (90.2%) by ureteroscopy and by percutaneous techniques or both approaches in 2 cases each (5%). Follow-up was between 5 and 115 months (mean 41.6 months). Most of the patients, 26 (65%), had a normal contralateral kidney, and the indication for conservative management was low tumor grade or tumor size (<2 cm) and patient commitment to a rigorous followup protocol. Absolute and relative indications for conservative management such as solitary kidney were met in 14 patients (35%). Results: Treatment consisted of electrocautery only in 15 cases (36.6%), neodymium:YAG or holmium:YAG laser only in 11 (26.8%), and combinations in 15 (36.6%). Most of the patients (74.3%) had an upper-tract recurrence. The renal-preservation rate was 70.7%, and the survival rate was 80%. Conclusions: Conservative treatment is preferred in patients with bilateral disease, a solitary kidney, or comorbidities that contraindicate major surgery. Patients with low-grade, low-stage disease and normal contralateral kidneys also benefit from this approach provided adequate endoscopic follow-up can be achieved and the surgeon has a low threshold for carrying out ablative surgery.