Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience

BACKGROUND: The efficacy and long-term results of endoscopic management of upper tract transitional cell carcinoma (TCC) were examined. The authors evaluated the accuracy of endoscopic biopsy in determining tumor grade in the subset of patients who underwent open surgical excision. METHODS: Between 1987 and 2001, 50 patients (17 with a solitary kidney) underwent ureteroscopy and biopsy of upper tract TCC. Eleven patients underwent ureterectomy or nephroureterectomy shortly after endoscopic biopsy. There was no follow-up for nine patients. Thirty patients underwent endoscopic ablation of their primary tumor with laser or electrofulguration at the time of the initial biopsy and were followed with close endoscopic surveillance at 3-4-month intervals. RESULTS: For the 30 patients who underwent endoscopic ablation, mean follow-up was 38 months (range, 4-106 months). There was an average of 3.4 recurrences, with an average time to first recurrence of 7 months. Ten of the 30 patients underwent open resection during follow-up. Six patients exhibited tumor progression at follow-up. During the follow-up period, one patient died of recurrent disease, and six died of other causes. Endoscopic biopsy accurately predicted the tumor grade for 8 of the 9 patients who had open tumor resection within 2 months of their last biopsy and for 10 of the 11 patients who had open resection shortly after their initial endoscopic biopsy (overall accuracy, 18 of 20 90%]). CONCLUSIONS: Endoscopic treatment of focal low-grade TCC of the upper urinary tract is feasible and safe, provided that vigilant follow-up and endoscopic surveillance are performed. Endoscopic biopsy provides accurate information regarding tumor grade.