Endourology for upper tract lesions

Nephroureterectomy with excision of cuff of bladder is the standard treatment of upper tract transitional cell carcinoma. Role of endoscopic treatment, either percutaneous or ureteroscopic, has been established in imperative indications like solitary kidney, bilateral tumors and deranged renal functions. Elective indications of endoscopic treatment include tumor size <1.5cm, low grade tumors with normal contralateral kidney. The most important pact which affects the success and prognosis following endoscopic treatment is careful selection of patients andregular ureteroscopic surveillance following surgery. Various studies have compared nephroureterectomy with endoscopic treatment in low grade tumors and concluded that both cancer related and overall survival is same in both the approaches. Adjuvant therapy with mitomycin, thiotepa and BCG has been described. However no study has shown statistical improvement regarding survival and recurrence rates following adjuvant therapy. Patients with low grade, small sized tumors have equal outcomes with endoscopic treatment as compared to expirative surgery with the advantages of minimal morbidity and preservation of renal parenchyma following endoscopic management. For the standardization of endoscopic treatment for patients with normal contralateral kidney, large randomized trials with long follow up results are needed.