| REVIEW ARTICLE |
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| Year : 2010 | Volume
: 26
| Issue : 2 | Page : 177-182 |
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Endoscopic management of upper tract transitional cell carcinoma
James A Forster1, Victor Palit2, Anthony J Browning2, Chandra Shekhar Biyani2
1 Department of Urology, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Cottingham, East Yorkshire HU16 5JQ, United Kingdom
2 Department of Urology, Pinderfields General Hospital, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, West Yorkshire WF1 4DG, United Kingdom
Correspondence Address:
Chandra Shekhar Biyani
Department of Urology, Pinderfields General Hospital, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, West Yorkshire WF1 4DG
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-1591.65382
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Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm of the upper urinary tract. The "gold standard" management of upper tract TCC is nephroureterectomy. Technological innovations, miniaturisations and increased availability of energy sources such as Holmium laser fibers have improved the armamentarium of endoscopic management of upper tract TCC. Endoscopic management of upper tract TCC includes the percutaneous (antegrade) and retrograde approaches. Modern flexible ureterorenoscopy allows retrograde approach to small (<1.5cm), low grade and non-invasive tumors, which is inaccessible to standard rigid ureteroscopes without breaching the urothelial barrier. In patients with large tumors or in whom retrograde access is difficult, the percutaneous approach to the renal pelvis, although more invasive, provides an alternative access and control. Both retrograde and percutaneous approaches allow instillation of various chemotherapeutic agents. Careful selection of patients is the key point in the successful endoscopic management of upper tract TCC. Patient selection is based on tumor size, grade and multifocality and other patient factors such as comorbidities, single kidney, post kidney transplant and patient choice. Both motivation and compliance of patients are needed for long-term successes. However, until large randomized trials with long term follow-up are available, endoscopic management of upper tract TCC should be reserved for only selected group of patients. This review summarizes the current techniques, indications, contraindications and outcomes of endoscopic management of UTTCC and the key published data.
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