الفهرس 
APPLIED ENDOSCOPIC ANATOMY OF THE UPPER URINARY TRACTOnly 14 pages are availabe for public view
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Abstract
The gold standard treatment for upper tract TCC has been nephroureterectomy with excision of a cuff of bladder. However, advances in percutanous and endoscopic techniques have allowed more conservative nephron sparing procedures for patients who have solitary kidneys or are otherwise not ideal candidates for open surgical resection.
In the early 1980’s ureteroscopic and percuteness techniques become more refined allowing access to the upper urinary tract and calyceal system with the development of ureteroscopic biopsy instruments as well as small diameter, flexible laser fibers (holmium:YAG and neodymium:YAG), accurate diagnosis and treatment of small tumors has become feasible and stage.
It is imperative that patients are properly selected for endoscopic treatment. In contrast to cystoscopic techniques where biopsy yields accurate staging of the tumor, ureteroscopic biopsy of upper tract tumors usually does not yield deep or full thickness sample to allow microscopic determination of invasion. Staging is therefore limited to the grade of the tumor. There is a well established correlation between tumor grade and stage.
The main message from series of endoscopic management of upper tract urothelial cancer is that patients must be carefully selected. Patient selection is based on tumor size, grade and multifocality. Single low-grade tumors less than 1.5 cm in size generally have good outcome with endoscopic treatment provided that they have regular ureteroscopic surveillance. Ureteroscopic treatment of high-grade tumors is essentially palliative.
However more than one-third of patients with endoscopically treated upper-tract TCC will develop tumor recurrence. To reduce the clinical evolution, adjuvant topical immunotherapy or chemotherapy remains a strong recommendation.
Various supplemental therapies have been attempted in the previously reported series including BCG, MMC, thiotepa and interferon α-2. Of these agents the two most promising were BCG and MMC. BCG therapy has been reported to provide cure in approximately 50% of renal units with CIS and several studies also support the use of BCG for upper tract CIS.
The endoscopic approach can be considered as an alternative approach to nephroureterectomy in poor performance status patients but until large randomized trials with long-term follow-up are performed, it cannot be considered as a standard treatment.