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Treatment options for upper tract transitional-cell carcinoma.

Nephroureterectomy with a bladder cuff remains the gold standard of treatment of transitional-cell carcinoma of the upper urinary tract. The natural history of the disease, specifically its multifocal nature and its propensity for local recurrence, argues for an aggressive treatment approach. Good clinical results using renal-sparing treatment of low-grade ureteral tumors reveal the feasibility of renal-sparing approaches in limited circumstances. It is likely that, with increasing use of renal-sparing therapy by endoscopic means, topical chemotherapeutic agents will take on an analogous role in the treatment of superficial disease and their role on the treatment of bladder cancer.