Conservative management for transitional cell carcinoma of the upper urinary tract.

Transitional cell carcinoma of the upper urinary tract most frequently occurs in the sixth and seventh decades of life. Standard care for these tumors involves a nephroureterectomy with removal of a cuff of bladder. Many investigators now recommend parenchymal-sparing operations in selected patients to avert the previous inevitability of dialysis. Recently, advancements in endoscopic technology have afforded two new, less invasive complementary techniques for the diagnosis and treatment of these lesions: ureteroscopy and nephroscopy. Ureteroscopy, due to its less invasive nature, is generally used as a first line approach to diagnosis and treatment. Those tumors which are not accessible from a ureteroscopic approach or are simply too large for adequate resection may be excised by nephroscopic means. Early results of endoscopic intervention appear to be comparable to open parenchymal-sparing procedures.