Upper urinary tract urothelial tumor. Antegrade percutaneous management

Abstract Upper urinary tract tumors account for 2-4% of urinary tract tumors and 5% of urothelial tumors. The pyelocalyceal system (75%) and distal third of the ureter are the most frequent locolizations. Various series confirm a relatively benign course of low grade and stage tumors, with survivals around 80-66% for pyelic and ureteral tumors respectively. Tumor grade and stage are the most important factors for patient outcome, more than type of treatment undertaken (classic radical nephroureterectomy vs. conservative surgery). With the development of endoscopic techniques and the use of new equipment, both ureteroscopy and nephroscopy have gained a relevant role in the study and treatment of upper urinary tract tumors in selected groups of patients. We describe data from the literature about the nature of urothelial tumors, diagnostic methods, and indications of conservative management. We performed a retrospective chart review of patients undergoing endoscopical procedures (ureteroscopy and nephroscopy) to rule out upper urinary tract urothelial tumors at the Hospital Ramon y Cajal in Madrid between January 1996 andJune 2003. We do a comparative analysis between our results and those referred in the literature and a previous study in our department published in 1996. Both ureteroscopy and nephroscopy are effective and safe procedures in the diagnosis and treatment of suspicious-looking lesions of the urinary tract, with a low complication rate. Main indications are small, papillary, and low grade tumors, confined within the mucosa, with negative urinary cytolo,gy, in patients with associated comorbidity, solitary kidney or bilateral tumors.