The use of 123I-Hippuran renography in the management of synchronous bilateral upper urinary tract transitional cell carcinomata

Bilateral simuitaneously occurring malignant tumours of the upper tracts are very rare, and present the difficult problem of preservation of renal function and adequate tumour clearance. We report such a case and discuss the difficulties and value of the modern methods of management, including ureteroscopy and 123I-Hippuran gamma camera renography with creatinine clearance to assess total and split renal function and recovery. A 62-year-old housewife was referred with right loin and back ache associated with haematuria. Two years earlier she had been investigated for right loin pain without haematuria and had normal excretion urography at that time. A repeat urogram revealed a radiolucent filling defect in the upper pole calyx of the right kidney (Fig. la), with hydronephrosis and hydroureter on the left side resulting from probable tumour in the distal ureter (Fig. 1b). Serum creatinine was normal. A 123I-Hippuran renogram demonstrated the obstructed left kidney to contribute 36% of global function. At i...