Trattamento nephron sparing delle neoplasie dell' alta via escretrice.

Nephroureterectomy with excision of a cuff of bladder remains the standard for managing upper tract transitional cell carcinoma, which could, in selected cases, be managed conservatively. In 10 years we have treated 67 reno-ureteral unities (r.u.u.) for urothehal tumors; 36 r.u.u. with low-stage and low-grade disease (28 patients, 8 with bilateral tumor and 2 solitary kidney), were treated by an endoscopic approach; in 34 cases (3 for high grade recurrences after conservative approach) nephroureterectomy was performed. In 36 r.u.u. treated by ureteroscopic approach, we observed 3 high-grade recurrences (nephroureterectomy) and 22 low-grade (G1-G2) recurrences. Each r.u.u. received an average of 2.08 ureteroscopic operative procedures. The patients were followed up fora mean of 47.6 months after initial treatment and currently they are all recurrence free. Nine patients (13,4%) with suspect tumor of the upper tract had no carcinoma in the ureteroscopic biopsy. Ureteroscopic approach of upper urinary tract urothelial tumors in the current literature has been used successfully, resulting in recurrence rates ranging from 31% to 65% and disease-free rates of 35% to 86%. Progression and metastatic rates are low and correlate with tumor grade. [ABSTRACT FROM AUTHOR]