title: Retrograde endoscopic laser therapy for transitional cell carcinoma of the upper urinary tract.
abstract: OBJECTIVE
  The aim of the present study was to investigate the safety and efficacy of endoscopic laser therapy for transitional cell carcinoma (TCC) of the upper urinary tract.
  
  
  METHODS
  Tumors of the renal pelvis and ureteropelvic junction were detected by ureteroscopy. The tumors were subjected to biopsy, and after TCC was diagnosed, endoscopic laser therapy (Neodymium-YAG and Holmium-YAG) was conducted using a 6.9 Fr. flexible ureterorenoscope.
  
  
  RESULTS
  From January 1997 to April 2002, six patients underwent ureteroscopic treatment. Tumor grade was 1 in four patients and 2 in two patients. Average tumor size was 1.45 cm. Endoscopic treatment was chosen for two patients because of the high medical risk associated with open surgery. Another patient underwent diagnostic ureteroscopy, followed immediately by endoscopic treatment. A further three patients elected to undergo ureteroscopic treatment. One patient with large (3 cm), multifocal and incompletely treated tumors died of metastatic disease 22 months after the initial operation. One patient requested nephroureterectomy one month after endoscopic treatment, and pathological examination of the resected specimen revealed no tumor. The other four patients have been followed up for a mean period of 14 months after initial treatment. Recurrence occurred in one patient, and was successfully treated by repeat endoscopic resection. None of the patients required blood transfusion or emergency open surgery.
  
  
  CONCLUSIONS
  Ureteroscopic treatment of small, localized, low-grade TCC of the upper urinary tract is now a safe and feasible alternative to nephroureterectomy in selected patients.
authors.affiliation: Department of Urology, Seirei Mikatahara General Hospital, Hamamatsu, Japan. mugiya@sis.seirei.or.jp
authors.forename: Soichi
authors.initials: S
authors.lastname: Mugiya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Maruyama
authors.forename: Masao
authors.initials: M
authors.lastname: Nagata
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Hadano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagae
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*; D014571:Urologic Neoplasms / Q000601:surgery*