title: Totally endoscopic management of upper tract transitional-cell carcinoma.
abstract: OBJECTIVE
  Nephron-sparing therapy arose spurred by efforts to delay dialysis for patients with renal insufficiency or solitary kidneys. As technology has improved, complete endoscopic ablation of tumor via the holmium and Nd:YAG lasers has proven efficacious for cancer control. We have extended ureteroscopic treatment to patients with normal contralateral kidneys given the proper indications. For required extirpative therapy in cases of uncontrolled cancer, laparoscopic nephroureterectomy is rapidly becoming popular and appears to lend the same tumor control as open surgery while significantly lessening morbidity. We reviewed our experience with endourologic treatment and propose an algorithm for the management of upper tract TCC.
  
  
  METHODS
  Over the period from August 1998 to May 2000, 70 patients underwent ureteroscopic evaluation, treatment, or both for TCC. During the same period, 24 patients had a hand-assisted laparoscopic nephroureterectomy (HALNU) performed. A thorough chart review was performed to determine pathologic data and management decision-making.
  
  
  RESULTS
  Of the 70 patients evaluated ureteroscopically, 46 were examined for the first time, while the remaining 24 patients were already on the surveillance protocol. Of the 46 initially evaluated patients, 18 were referred for HALNU. Fifteen other patients were placed on surveillance. Of the 24 patients already on surveillance, only 1 required HALNU. The most common reasons for nephroureterectomy were bulky tumors that were ureteroscopically unresectable, high-grade disease, and patient preference.
  
  
  CONCLUSIONS
  The combination of ureteroscopy and laparoscopy has made the management of upper tract TCC totally endoscopic, providing decreased morbidity while maintaining cancer control.
authors.affiliation: Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.forename: Edouard
authors.initials: E
authors.lastname: Trabulsi
authors.forename: David
authors.initials: D
authors.lastname: McGinnis
authors.forename: Stephen
authors.initials: S
authors.lastname: Strup
authors.forename: Leonard G
authors.initials: LG
authors.lastname: Gomella
authors.forename: Demetrius
authors.initials: D
authors.lastname: Bagley
mesh_terms: D000465:Algorithms; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D009392:Nephrectomy; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000601:surgery*