Modern Endourologic Management of Clinically Localised Upper Urinary Tract Urothelial Tumours

ContextIndications, current endoscopic management, adjuvant therapies, and follow-up regimens in renal conservational management of upper urinary tract transitional cell carcinoma (UUTT) are described.ObjectiveThis short review emphasises contemporary endoscopic diagnostic and therapeutic ablative options and includes information about adjuvant therapies and surveillance protocols in patients with low- or intermediate-risk UUTT selected for renal conservation.Evidence acquisitionEvidence was acquired from a review of the recent published literature over the past 15 yr, with key articles selected from expert centres.Evidence synthesisKey points from cited articles were summarised in the review and blended with new material based on emerging techniques and technology along with expert experience.ConclusionsThe major findings of this review suggest that when optimally performed using a meticulous technique with appropriate equipment both for diagnosis and treatment in expert centres, safe renal conservation is possible in a defined UUTT population, even when a normal contralateral kidney is present. A strong case can be made for challenging the age-old paradigm that nephroureterectomy should be uniformly applied as the first-line treatment for all patients with suspicious filling defects in the upper urinary tract or proven clinically localised UUTT, provided there is no high grade-stage, or an imperative for renal preservation.