Rigid Uretero-Resectoscopic Management of Ureteral Tumors

Abstract

Ureteroscopic resection of upper tract is indicated by patient preference, medical comorbidities, and location/size of tumor. The literature on ureteral recurrence reports a recurrence rate of 48% for low grade and 60% for high grade, but the real recurrence rate is likely to be higher. Risk factors for recurrence include size >2 cm, grade, prior history of urothelial cell carcinoma and stage. The most important factor appears to be grade. Patients who failed conservative therapy and had a delayed radical nephroureterectomy had similar disease-specific survival and pathological stage to those who choose immediate radical nephroureterectomy. In our experience, ureteral tumors are best treated with ureteraoresectoscope. One must be careful with resecting near vessels such as the iliacs in the mid-ureter. In many cases, the resection will need to be staged secondary to the bulky nature of the tumor. If the lesion appears to be extensive or high grade, we instill Mitomycin C at the end of the procedure.