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Ureteroscopic management of upper urinary tract transitional cell carcinoma

Purpose of review Traditionally, nephroureterectomy has been the treatment of choice for transitional cell carcinoma of the upper urinary tract. In an effort to preserve renal function, conservative therapy has evolved from complex open surgery to minimally invasive ureteroscopic therapy. Considering the relatively recent emergence of ureteroscopic therapy, a review of technical considerations and treatment outcome is timely. Recent findings There is emerging evidence that ureteroscopic treatment of low grade upper tract lesions provides an acceptable oncologic result while preserving functioning renal parenchyma. In patients with low grade upper tract urothelial lesions, progression is rarely reported. Ureteroscopy has for over a decade been the premier diagnostic tool, with the actively deflectable flexible instrument being employed to map the entire intrarenal collecting system. Improvements in instrumentation and refinement in technique have broadened the application of the ureteroscope in treating upper urinary tract urothelial tumors. Summary For low grade lesions, which make up more than 50% of all presentations, ureteroscopic management has proven efficacious. As with similar grade lesions in the bladder, these patients require careful, consistent, and often lifelong follow up as many will develop recurrent lesions throughout the urothelium. Here too, ureteroscopy has a central role in surveillance.