[Ureteroscopy in the follow-up protocol for upper urinary tract urothelial tumors treated endoscopically].
OBJECTIVE
To evaluate the role of ureteroscopy (rigid and flexible) in the follow-up protocol for transitional cell tumors treated conservatively in our department by endourological procedures, and to review the articles on this topic available in the literature.


METHODS
From February 1997 to June 2003, 10 patients (12 renal units) with upper urinary tract urothelial tumor treated conservatively by endourological procedures were followed by cytology, cystoscopy, retrograde ureteropyelography, and ureteroscopy (rigid and flexible), quarterly during the first year, semi-annually during the second year, and yearly thereafter in order to detect tumor recurrence.


RESULTS
Mean follow-up was 31.9 months (R 14-65). Two patients died: one because of a previous metacronous bladder tumor and the other after distant progression. One patient was lost to followup. A total of 42 ureteroscopies were performed (31 flexible and 11 rigid). Flexible ureteroscopy was performed in 6 patients and rigid ureteroscopy in three; neither was feasible in one patient so that follow-up was done by cytology, cystoscopy and urography. Tumor recurrence was detected in 2 patients but ureteroscopy did not inform about tumor stage. Flexible ureteroscopy failed in another patient in which rigid ureteroscopy was feasible. Although this latter was technically easier to perform, procedure discomfort was worse.


CONCLUSIONS
The follow-up of transitional cell tumors of the upper urinary tract should be very strict because of the high risk of tumor relapse. Ureteroscopy, mainly flexible, is standing out as the most effective procedure to watch these tumors.
Amón Sesmero
José H
JH
Servicio de Urología, Hospital "Pio del Rio Hortega", Valladolid, España. jhamon@terra.es
Estébanez Zarranz
Javier
J
Conde Redondo
Consuelo
C
Robles Samaniego
Alberto
A
Del Valle González
Noelia
N
Martínez-Sagarra Oceja
José Ma
JM
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy; D014551:Urinary Tract / Q000473:pathology / Q000601:surgery