What is the role of endoscopy in renal transitional cell carcinoma treatment?

Updated: Nov 05, 2019
  • Author: Bagi RP Jana, MD, MBA, MHA, FACP; Chief Editor: E Jason Abel, MD  more...
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Answer

Urothelial tumors of the upper urinary tract can be excised by means of endoscopy in much the same fashion as superficial bladder tumors are. Indications for endoscopic management are the same as those for conservative resection and include low-grade tumors, bilateral involvement, and compromised renal function that necessitates a nephron-sparing approach.

Electrocautery and fulguration are used most commonly in the endoscopic setting. Currently, lasers (Ho:YAG and Nd:YAG) are being used for management of low-grade upper urinary tract urothelial tumors.

In cases of larger low-grade tumors with low metastatic potential, which cannot be eliminated during one session, ureteroscopic management can be performed several times.

Tumor size (>1.5 cm), multifocal disease, and high-grade tumors are the main risk factors for recurrence after ureteroscopic management of upper urinary tract UC. The presence of high-grade or invasive tumors, which cannot be eradicated endoscopically, necessitates radical surgical intervention (usually involving open or laparoscopic nephroureterectomy).


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