Ureteropyeloscopy: the diagnostic and therapeutic approach to upper tract urothelial tumors
Rigid transurethral ureteropyeloscopy allows many standard cystoscopic procedures to be extended into the upper urinary tract, including endoscopic diagnosis, surveillance, and occasionally primary treatment. This endoscopic method has been used to investigate 59 patients suspected to have urothelial malignancies of the ureter or renal pelvis. Of the 54 patients in whom the procedure was successfully completed (90%), 27 were found to have urothelial tumors of the ureter or renal pelvis. Nephroureterectomy was subsequently performed in 6 of these patients and segmental ureterectomy in 3 patients, enabling pathologic correlation with the endoscopic mapping. However, in 16 patients, ureteroscopy and biopsy revealed apparently localized, low-grade tumors which were treated by ureteroscopic fulguration or resection. The latter patients and the 3 patients who underwent segmental ureterectomy have undergone endoscopic surveillance every 3 months (average follow-up 16 months). The technique of ureteropyeloscopy permits endoscopic access into the ureter and renal pelvis enabling tissue diagnosis and better preoperative cancer staging without surgical exploration. Although follow-up is short, selected patients with low-grade tumors may be treated primarily by endoscopic means. © 1985 Springer-Verlag.
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