Primary neoplasms of the ureter.

The role of tobacco as a carcinogenic agent should be considered in ureteral carcinoma. In our study 77 per cent of the patients had a history of smoking, with an average of 50 packs a year consumption. Various studies have shown that the prognosis for ureteral carcinoma is related primarily to the grade and stage of the disease at the time of treatment. Therefore, it is imperative that the clinician maintain a high index of suspicion. This index of suspicion should be heightened in any patient with lower tract urothelial tumors. In addition to endoscopic followup excretory urography should be done on an annual basis, with retrograde studies when necessary. Ureteral brush biopsies or tissue obtained with the Dormia basket may be diagnostic. A Dormia stone basket was used in 3 patients in our study and sufficient tissue for diagnosis was obtained in each case. No complications were encountered. The results obtained in treating a primary leiomyosarcoma of the ureter are noteworthy in that complete remission of pulmonary metastases was obtained after the patient received a course of doxorubicin hydrochloride and dimethyl-triazeno imidazole carboxamide.