Clinical studies on primary ureteral tumors

The 15 cases of the primary ureteral tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The incidence of primary ureteral tumors among the outpatients in our urologic clinic was 0.15%. The patients ranged in age from 50 to 75 years old (average: 65.5 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The right ureter and the lower third of the ureter were involved more frequently than other areas. The most frequent symptom was macrohematuria which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 11 cases (73.3). Positive urinary cytology was obtained in 9 cases (60%). Twelve patients underwent nephroureterectomy with bladder cuff or total cystectomy. Histologically, all cases were transitional cell carcinoma. Simultaneous urothelial tumors were seen in the bladder in 4 cases (26.7%). The over-all actual survival rates at 1, 3 and 5 years were 59%, 42%, 42%, respectively. The 5-year actual survival rate was 63% for the low grade group and 0% for the high grade group. The 5-year actual survival rate was 82% for the low stage group and 0% for the high stage group. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis.     

Clinical study of renal pelvic tumors

A retrospective study was conducted on 22 patients with renal pelvic tumor treated at our University Hospital between 1970 and 1984. The patients included 18 males and 4 females, from 31 to 81 years of age. The left kidney was involved in 14 cases, and the right in 8. More than 60% of them also presented gross hematuria. IVP abnormalities included filling defects in 9 cases and non-visualizing kidney in 8 cases. Pretreatment urinary cytology was positive in 65.7%. Radical nephroureterectomy was performed in 18 cases, followed by adjuvant therapy in 10 cases; radiation in 5 cases, chemotherapy in 4 cases, and radiation/chemotherapy in one case. Histology revealed transitional cell carcinoma in all cases. On diagnosis, simultaneous urothelial tumors were identified in one case in the ureter and the bladder, and in one case in the bladder. Tumor development after surgery was observed in 9 cases, 8 in the bladder and one in the ipsilateral renal pelvis. The 5-year actual survival rate was 58.2% over all: that of the low-grade group was 100%; that of the high-grade group, 45.1%; that of the low-stage group, 100%; that of the high-stage group, 19%. In conclusion, the prognosis in our series was significantly influenced by the stage and grade of the tumor.     

A clinicopathological study on tumor of the renal pelvis and ureter

We report 42 patients with urothelial tumors in upper tract admitted to our hospital between August, 1969 and August, 1988. The patients consisted of 33 males and 9 females; their ages ranged from 42 to 85 years with a mean of 66.2 years. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 24 cases, total nephroureterectomy without bladder cuff resection in 11 cases, total nephroureterectomy with total cystectomy in 2 cases and partial ureterectomy only in 2 cases. Tumor lesions had a positive correlation with grade and stage. The survival rate for all the patients at 1, 3 and 5 years was 76.0, 58.8 and 54.6%, respectively, as measured by the Kaplan-Meier's method. The prognosis of the patients with renal pelvic tumor and ureter tumor was dependent upon grade, stage and intravascular tumor-emboli. Vesical recurrence was observed in 10 cases and found frequently in low grade tumor and/or low stage tumor cases. The frequency of vesical recurrence was not positively correlated with cuff resection The 5-year survival rate was not different between the patients with vesical recurrence and those without vesical recurrence.     

Intermediate followup of hand assisted laparoscopic nephroureterectomy for urothelial carcinoma: factors associated with outcomes

PURPOSE: We report our experience with hand assisted laparoscopic (HALS) nephroureterectomy and describe the associations of preoperative, operative and pathological factors with outcome. MATERIALS AND METHODS: HALS nephroureterectomy was performed in 54 consecutive patients using modified transurethral resection of the ureteral orifice (TURUO) or a 1 port transvesical endoscopic cuff technique for the distal ureter in all except 8. Data were collected prospectively and retrospectively, and followup was distinguished for bladder, contralateral upper tract and nonurothelial (local recurrence and distant metastases) sites. RESULTS: The endoscopic cuff was associated with significantly shorter mean operative time than the transurethral resection of the ureteral orifice method (234 vs 295 minutes, p = 0.002) but the comparison was confounded by the effect of experience. With 28% of patients having stage II or greater tumors and 49% having high grade bladder disease, contralateral upper tract and nonurothelial recurrences developed in 55%, 11% and 25% of evaluable patients at a median followup of 25.1, 24.4 and 24.9 months, respectively, in those without recurrence. At a median followup of 25.0 months cancer specific survival was 94%, 86% and 80% at 1 to 3 years, respectively. Three-year cancer specific survival was 100% in patents with grade 1 or 2, or stage 0 or I tumors but only 57% and 36% in patients with grade 3 and stage II or IV tumors, respectively. CONCLUSIONS: HALS nephroureterectomy is associated with 3-year outcomes that are strongly associated with stage and grade. We prefer the endoscopic cuff method for the distal ureter because it is performed after nephrectomy, does not require patient repositioning and is expedient.     

Prognostic factors for survival and bladder recurrence in transitional cell carcinoma of the upper urinary tract

BACKGROUND: Prognostic factors for survival in transitional cell carcinoma of the upper urinary tract have been extensively evaluated, but detailed analyses of patterns of bladder recurrence after surgery have been rare. METHODS: The outcome and tumor recurrence of 93 patients with transitional cell carcinoma of the upper urinary tract surgically treated between 1975 and 1999 were reviewed, retrospectively. Disease-specific survival by pathologic stage and grade were analyzed by the Kaplan-Meier METHOD: Prognostic factors for survival and bladder recurrence were examined by univariate and multivariate analysis. RESULTS: The 5-year disease-specific survival rates of the patients with pTa, T1 and T2 were 92.9%, 100% and 88.9%, respectively. However, that of the pT3 patients was 61.9% and the median survival of the pT4 cases was only 7 months. Bladder recurrence was seen in 40 cases and recurrences occurred within 1 year in 32 of these patients. The stage and grade of metachronous bladder tumors usually resembled those of primary tumors, but invasive recurrences were seen in 19% of recurrent cases with primary pTa, pT1 tumors. The significant prognostic factor for survival was pathologic stage (pT3, pT4), but no significant variables were detected for bladder recurrence by multivariate analysis. CONCLUSIONS: The prognosis of pT3, pT4 patients is poor and effective systemic adjuvant therapy is necessary. Invasive bladder recurrence occurred in 19% of patients with superficial primary tumors. As no significant prognostic variables for bladder recurrence were identified, careful follow up for bladder recurrence is important even if the primary tumors are non-invasive.     

A clinical study on primary ureteral tumors

Twenty-two cases of primary ureteral tumors treated at our Department between July 1971 and December 1984, were reviewed. The patients ranged from 28 to 83 years old (average 63.6 years). There were 17 males and 5 females (3.4:1). The affected side was predominantly the left (15) than the right (7). The most common site of the tumor growth was at the lower third of the ureter (14 cases, 63.6%). The most common initial symptom was macroscopic hematuria, which was seen in 17 cases (77.3%). The major finding of IVP was non-visualizing kidney in 11 cases (50.0%) and filling defect in 7 cases (31.8%). Positive urinary cytology was obtained in 9 cases (52.9%) by voided urine and 6 cases (66.6%) by catheterized urine. Total nephroureterectomy associated with partial cystectomy was performed in 14 cases (63.6%). Histologically, 19 cases were transitional cell carcinoma (86.8%). Associated growth of urothelial tumor in the bladder was found in 4 cases preoperatively and in 3 cases during the course of postoperative follow up. All of them were treated by transurethral resection. Overall survival rate at 1,2,3,4 and 5 years was 84, 71, 55, 46 and 35%, respectively, by the Kaplan-Meier method. The five year survival rate was 54% for the low stage group and 0% for the high stage group; 54% for the low grade group and 26% for the high grade group. (p value = not significant, generalized Wilcoxon test).     

A clinical study on renal pelvic and ureteral tumors

Thirty-seven cases of renal pelvic and ureteral tumors treated at our hospitals between January, 1975 and December, 1985 were reviewed. There were 15 renal pelvic tumors, 19 primary ureteral tumors and 3 ureteropelvic tumors. There were 26 males and 11 females and their average age was 62.5 years old ranging from 37 to 82. The most frequent chief complaint was macroscopic hematuria, which was seen in 89% of the patients (33/37). It was 35% of the patients (13/37) who visited our hospitals more than one month but less than three months after the appearance of symptoms. The positive rate of urine cytology was 69%. Total nephroureterectomy was performed on 22 patients and the other surgical treatments were done on 13 patients. Histological examination revealed transitional cell carcinoma in all cases. The overall actual postoperative survival rate at 1, 3 and 5 years was 83.9%, 68.0% and 68.0%, respectively, as measured by the Kaplan-Meier's method. None of the patients who survived more than 3 years after surgery died. The actual 3 and 5 year survival rates in cases of ureteropelvic tumors were slightly lower than those in the case of bladder tumors. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy.     

A clinical study of tumor of the renal pelvis and ureter

We report 54 patients with urothelial tumors in upper urinary tract admitted to our hospital between July, 1962 and December, 1985. The patients consisted of 38 males and 16 females; side their ages ranged from 47 to 88 years with a mean of 63.4 years. The affected side was the right side in 21 cases, and the left side in 33 cases. Macro-or microhematuria was observed in 87% of the patients. Pathologically, 53 of the patients had transitional cell carcinoma and 1 had papilloma. Six patients had a past history of bladder tumor. Simultaneous bladder tumor was identified in 10 cases. Vesical recurrence was observed in 5 cases. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 21 cases, and total nephrectomy without bladder cuff resection in 11 patients. The actual five-year survival rate was 53% for all the patients; 52% for patients with renal pelvic tumors, 75% for those with ureteral tumors and 15% for those with renal pelvic and ureteral tumors. The patients who received nephroureterectomy had a postoperative survival rate similar to that of those who received nephroureterectomy with bladder cuff resection. A simultaneous bladder tumor lowered the survival rate.     

Clinical studies of the patients with primary renal pelvis cancer

Sixteen patients with transitional cell carcinoma of the renal pelvis seen at our Hospital between December 1973 and February 1984 were reviewed and the diagnostic tools were evaluated. The patients (11 males, 5 females) ranged in age from 35 to 81 years (mean 63.8). Ten tumors were found on the left side and 6 on the right side. The most frequent symptom was macrohematuria (93.8%). Total nephroureterectomy including the cuff was performed in 11 cases, simple nephrectomy in 2 cases and partial nephrectomy in one case. Lymphadenectomy was performed in 4 cases. According to the general rules for clinical and pathological studies on bladder cancer in Japan, 5 cases were classified grade 1, 6 cases as grade 2 and 3 cases as grade 3. According to Cummings' staging, 2 cases were in stage 1, 4 in stage II, 7 in stage III and 3 in stage IV. The cumulative survival rate at 5 years was 34.1% by Kaplan-Meier's method. The diagnostic tool contributing to the confirmation of the renal pelvic cancer was the retrograde pyelogram in 12 out of 15 patients (80.0%).     

Clinical studies of patients with bladder cancers]

A clinical survey was performed on 185 cases of primary bladder cancer treated at our Department of Urology, between January, 1985 and December, 1989. Clinicopathological profiles of patients and survival rates according to these profiles were investigated. The patients were between 29 and 95 years old. The male to female ratio was 3.1 to 1. The cumulative survival rate after the first treatment was 73.3% and 71.5% at 3 and 5 years, respectively. Histologically, 17 cases were diagnosed as transitional cell carcinoma G1, 69 cases as G2 and 69 cases as G3. 5 cases were diagnosed as stage pTis, 6 cases as pTa, 41 cases as pT1, 15 cases as pT2, 9 cases as pT3a, 14 cases as pT3b and 6 cases as pT4. Stage, grade, size and type of tumors reflected the prognosis well. Significant differences were observed between the survival rates of the patients with grade G2 and grade G3, and the patients with stage T1 and stage T2. Although low-grade low-stage tumors recurred in 44% of the patients. The pathological stage showed a good relation to the grade. In particular, none of the G1 bladder tumors had muscle invasion in our series.     

Clinical and pathological study on 47 cases of renal pelvic and ureteral tumors

47 cases including 24 renal pelvic tumors, 20 ureteral tumors and 3 renal pelvic and ureteral tumors treated in our hospital from January, 1980 to December, 1987, were studied clinico-histopathologically. The patients ranged in age from 38 to 81 years (average 65 years) the sex ratio was 3:1 with male predominance over female. Tumor occurred on the right side in 19 cases, on the left side in 27 cases and bilaterally in 1 case. The most frequent sign was hematuria which was observed in 40 cases (85%). The interval from the onset of initial symptoms to the first visit was within one month in 9 cases (19.1%). The major findings of excretory urograms were filling defect in 21 cases (47.1%) and non-visualizing kidney in 15 cases (33.8%). Positive urinary cytology was obtained in 21 cases (44.7%). Operative therapy as performed in 45 cases, namely, nephroureterectomy and partial cystectomy in 30 cases (66.7%) and nephroureterectomy in 9 cases (20%). Histopathologically, all cases but two cases of squamous cell carcinoma and to cases of mixed type carcinoma are transitional cell carcinoma. Subsequent bladder tumors were found in 8 cases (17.7%). The overall survival rate at 1, 3 and 5 years were 80.2%, 41.1% and 41.1%, respectively by Kaplan-Meier method. In this series, the interval from the onset of initial symptoms, the grade and stage of tumor and metastasis of lymph nodes were to be considered in developing prognosis.     

Oncological outcome of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma

OBJECTIVE: To report the oncological outcome of retroperitoneoscopic nephroureterectomy (RNU) with bladder cuff excision for upper urinary tract transitional cell carcinoma (TCC), and to compare the outcome with that of the traditional open nephroureterectomy (ONU). PATIENTS AND METHODS: From January 2001, 48 patients with upper urinary tract TCC were enrolled in the study; 25 had RNU and 23 had ONU. Oncological parameters (disease-free survival and disease-specific survival) were calculated from the time of surgery to the date of last follow up and were analysed by the Kaplan-Meier method. RESULTS: Mean follow up was 24.3 months in the RNU group, significantly shorter than in the ONU group. Bladder recurrence was identified in two patients with grade 3 pathological stage pT3, one patient with grade 3 stage pT2 disease and two patients with grade 2 stage pT2 disease. Multiple organ metastases in the lung, liver and lymph nodes were associated with bladder recurrence in two cases (grade 2 stage pT3, and grade 3 stage pT3). The recurrence rate was 20% (5 of 25 cases) and mean time to recurrence was 9.5 months. In the ONU group, bladder recurrence and metastases developed in four and three patients, respectively. The recurrence rate was 17% (4 of 23 cases) and mean time to recurrence was 23.4 months. No significant difference was detected in the disease-free survival rate and cancer-specific survival rate between the two groups (P=0.759 and P=0.866, respectively). CONCLUSION: The oncological outcome of RNU appears to be equivalent to that of ONU. Moreover, long-term follow up is necessary to evaluate the oncological outcome in comparison to ONU.     

Survival rate of bladder tumors--an analysis of 2304 patients with bladder tumors in the Tokai Urological Cancer Registry

During the 7 years from 1980 to 1986, 2860 cases of bladder tumors were registered in the Tokai Urological Cancer Registry. Among the 2860 cases, 2304 cases were selected from the registered cases for the present study. The 5-year relative (actual) survival rates were 73.8% (61.9%) of all patients; 48.9% (42.4%) in those with malignant neoplasma of urinary bladder excluding transitional cell carcinoma; 48.8% (41/3%) in those with mixed tumor. In patients with transitional cell carcinoma, the 5-year relative (actual survival rates were 93.7% (78.8%) for G1, 87.2% (74.1%) for G2 and 47.3% (38.9%) for G3. As to staging, the 5-year survival rates were 101.9% (88.0%), 87.6% (75.3%), 57.9% (47.8%), 33.7% (28.2%) and 6.1% (5.0%) in patients with stage of Ta, T1, T2, T3 and T4, respectively. The tumors with muscle infiltration and high grade malignancy obviously deteriorated patients' survival. The 5-year relative (actual) survival rate for patients treated with TUR was 98.1% (82.2%). As to grading, the 5-year survival rates were 102.2% (86.6%) for G1, 104.3% (88.3%) for G2 and 56.9% (48.3%) for G3. The 5-year survival rates of those with Ta, T1 and T2 were 103.9% (89.7%), 96.0% (82.6) and 61.1% (49.1%), respectively. The 5-year relative (actual) survival rate for patients undergoing total cystectomy was 62.4% (52.3%). In those patients, the 5-year survival rates were 96.7% (80.9%) for G1, 63.6% (55.7%) for G2 and 55.4% (47.1%) for G3. As to staging, the 5-year survival rates were 102.3% (90.6%), 77.8% (68.2%), 56.3% (47.9%), 41.8% (34.9%) and 15.2% (13.1%) in patients with stage of Ta, T1, T2, T3 and T4, respectively. The 3 and 5-year relative (actual) survival rates in patients with advanced bladder tumors were 5.3% (4.8%) and 0.87% (0.73%), respectively.     

A clinical investigation on renal pelvic and ureteral tumors]

Sixty-six patients with renal pelvic and ureteral tumors were treated in our hospital between June 1974 and June 1991. These cases consisted of 27 renal pelvic tumors, 31 ureteral tumors and 8 renal pelvic and ureteral tumors. Their ages ranged from 43 to 86 years old (average: 65). There were 46 males and 20 females. The surgical method involved total nephroureterectomy with a cuff for 44 patients, nephroureterectomy for 3, nephrectomy for 9, total nephroureterectomy with total cystectomy for 5 and partial ureterectomy for 2. Histologically, there were 60 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC) and 4 TCC with SCC. As for the pathological stage, 13 were pTa, 16 pT1, 12 pT2, 11 pT3, 13 pT4 and 1 pTX. Subsequent bladder tumors were found in 13 patients (19.7%). The overall survival rate at 1, 3 and 5 years were 80%, 68% and 52%, respectively according to the Kaplan-Meier's method. In this series, the pathological staging was the most important prognostic factor.     

13-year survival comparison of percutaneous and open nephroureterectomy approaches for management of transitional cell carcinoma of renal collecting system: equivalent outcomes.

BACKGROUND AND OBJECTIVE: Transitional cell carcinoma (TCC) of the renal collecting system traditionally has been managed by open nephroureterectomy with en bloc resection of a bladder cuff. However, for a select patient population with a solitary kidney or bilateral disease, the morbidity and mortality associated with chronic renal insufficiency and dialysis is deterring. In these situations, a more conservative approach such as antegrade percutaneous resection should be considered. The long-term disease-free outcome of percutaneous management in comparison with open nephroureterectomy has not been previously reported. We evaluated our experience with two surgical approaches to treat upper tract TCC: percutaneous resection and nephroureterectomy/nephrectomy to assess the clinical efficacy of these surgical modalities. PATIENTS AND METHODS: We retrospectively identified 162 patients who had clinically localized TCC of the upper urinary tract. Records were reviewed to identify those with 13-year follow-up (N = 110) in respect to tumor grade, stage, disease-free status, length of cancer-specific survival, and overall survival. Statistical analysis of the results of open nephroureterectomy/nephrectomy (N = 60) and percutaneous resection (N = 50) was performed using Kaplan-Meier survival curves and Student's t-test. RESULTS: All patients had disease in clinical stage Ta through T3. During a mean follow-up of 46.6 (range 6-150) months, grade 1 disease demonstrated little invasive potential. Of the disease-specific deaths, 60% (17/26) were of patients with grade 3 lesions, with a mean cancer survival period of 15.2 months after the initial procedure. Disease-specific survival rates after open and percutaneous approaches for grade 2 disease were 53.8 and 53.3 months, respectively (P > 0.05). CONCLUSIONS: Tumor grade appeared to be the most important prognostic indicator in patients with renal TCC regardless of the surgical approach. Grade 3 tumors were more aggressive, presenting in an advanced stage with invasion, and recurrences were usually associated with metastasis. In this population, nephroureterectomy is warranted if the patient is a surgical candidate. The percutaneous option for grade 1 or 2 disease may be extended beyond the population with solitary kidneys and a risk of chronic renal failure to be offered to healthy individuals with normal contralateral kidneys who are willing to abide by a strict and lengthy follow-up.     

Transitional cell carcinoma of the kidney 25-year experience

Seventy patients with transitional cell carcinoma of the kidney operated upon at Barnes Hospital during the last 25 years are reviewed. The relationship of the pathologic stage, grade, findings on excretory urography and survival is studied. The stage and survival rates were predicted fairly accurately on the basis of the excretory urogram alone. Survival of patients was determined occasionally by the status of the associated bladder tumors more than by the renal cancer. Because of tumor multiplicity we recommend total nephroureterectomy as the treatment of choice. The role of radiation therapy is considered.     

Prognostic significance of bladder tumor history and tumor location in upper tract transitional cell carcinoma

PURPOSE: We studied prognostic factors for 5-year disease specific and recurrence-free survival in patients treated for upper urinary tract transitional cell carcinoma. MATERIALS AND METHODS: Since July 1987, 72 patients with a mean age of 58.9 years have undergone nephroureterectomy with bladder cuff excision. Median followup was 62.2 months (range 6 to 192). Patient age, sex, detection duration and mode, bladder tumor history, smoking habit, stone disease history, and tumor stage, grade and location were evaluated as prognostic factors. RESULTS: Overall 5-year disease specific and recurrence-free survival rates were 74.9% and 67.8%, respectively. Univariate analysis revealed anemia, positive bladder tumor history, T stage, grade and tumor location in the upper tract as significant prognostic factors. On multivariate analysis T stage, grade and tumor location in the urothelium were the only significant variables for the 5-year disease specific and recurrence-free survival rates. CONCLUSIONS: High tumor stage and grade, and ureteral location were significantly associated with worse disease specific and recurrence-free survival in patients with upper urinary tract transitional cell carcinoma. Our results may help define the patient groups that need adjuvant therapy and they may form a basis for further controlled studies.     

Clinical study of urothelial tumors of the upper urinary tract. 1: Primary renal pelvic tumors

Forty primary renal pelvic tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 30 males and 10 females (3: 1), and average age was 60.5 years old. The major symptoms were hematuria and flank pain; however, palpable mass was rare. The majority of patients were admitted to our clinic within 6 months from manifestation of symptoms. The major findings of IVP were non-functioning kidney and filling defect. The positive rate of urinary cytology was 46.7%. Total nephroureterectomy with bladder cuff was performed in 20 out of 32 cases. Histologically, 29 cases were transitional cell carcinoma and 4 cases were squamous cell carcinoma with renal calculi. Simultaneous urothelial tumors were seen in 10 cases, 3 in the ureter and 7 in the bladder. A subsequent ureteral tumor was found in one out of 12 cases in which ureters were resected incompletely, and 7 subsequent bladder tumors were found out of 32 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by the actuarial method was 75.9%. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.     

Clinical study of urothelial tumors of the upper urinary tract. 2: Primary ureteral tumors

Twenty-five primary ureteral tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 18 males and 7 females (2.6: 1), and average age was 63.04 years old. The major symptom was hematuria. The majority of the patients were admitted to our clinic within 6 months from manifestation of symptoms. The major finding of IVP was non-functioning kidney. The positive rate of urinary cytology was 63.2%. Total nephroureterectomy with bladder cuff was performed in 21 out of 23 cases. Histologically, 22 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumor was found in 13 cases in the bladder. Most of the ureteral tumors (63.6%) were found in the lower third segment of the ureter. Subsequent urothelial tumors were seen in 3 bladders and one urethra out of 22 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by actuarial method was 39.4%. Among several factors, grade and stage of tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.     

Treatment in 50 cases of transitional cell carcinoma in renal pelvis and ureter

A total of 50 cases of primary tumors in the renal pelvis and ureter were treated in Tokyo University Branch Hospital (20 cases in 1966-1982) and in Tranomon Hospital (30 cases in 1977-1987). They were composed of 42 men and 8 women (5.3:1) with a mean age of 61 years. 31 patients suffered from renal pelvic tumors, 15 ureteral tumors and 4 tumors in both sites. The tumors were located in the left side in 33 cases, right in 16, and both sides in 1.86% of patients showed gross hematuria. The findings on IVP were filling defect (42%) and nonvisualization (33%). Positive urine cytology was obtained in 12 of 25 cases (48%). Surgery was performed in 47 cases. The remaining 3 cases were with advanced diseases. The surgeries were total nephroureterectomy plus ipsilateral retroperitoneal lymph node dissection in 26 cases, total nephroureterectomy without node dissection in 7, total nephroureterectomy and total cystectomy in 3, nephrectomy in 9, partial nephrectomy in 1 and segmental excision of ureter with ureteroureterostomy in one. Histologically, all tumors were transitional cell carcinoma. Over-all survival rates (Kaplan-Meier's method) of the operated patients at 1, 3, 5 years were 84.2%, 73.1% and 69.4%, respectively. The stage and grade of the tumors affected the prognosis. N factor at lymph node dissection was the most determining factor of prognosis. 3 advanced cases who did not receive surgery for primary site were treated with 5FU in 2, and with CAP in 1.2 of them died of the disease within 1 year after diagnosis, one patient was lost in follow up.(ABSTRACT TRUNCATED AT 250 WORDS)