Ureteropyeloscopy for upper urinary tract lesions - Its techniques and applications

Since 1987, we have employed ureteropyeloscopic diagnosis and treatment for the patients with unilateral renal bleeding of uncertain etiology and upper urinary tract transitional cell carcinoma. The techniques and procedures have improved dramatically with the advancement of endoscopes and other related instruments. In this article, we introduce our recent procedures for ureteropyeloscopy with special reference to technical pitfalls. In addition, our clinical results are also reported. Between July, 1987 and September, 1999, 59 patients with essential hematuria were examined and treated endoscopically. The duration of gross hematuria was 1 to 144 months (average 29.5 months). The right side was affected in 21 patients, the left in 37, and both in 1 patient. The localized bleeding point was detected in 41 out of 59 patients. All these lesions were treated endoscopically. Among the 41 patients with localized bleeding, transitional cell carcinoma was found in 2, hemangioma in 14, minute venous rupture in 20, varices in 3 and calculus in 2. Between July, 1987 and September, 1999, we carried out endoscopic treatment for 16 patients with upper urinary tract transitional cell carcinoma. There were 3 patients who died of renal pelvic carcinoma, but there were no patients who died of ureteral carcinoma. However, the prognosis of patients with bilateral lesions, diffuse non-papillary carcinoma or preoperative positive urine cytology was particularly poor. In conclusion, ureteropyeloscopy is useful for the patients with unilateral renal bleeding of uncertain etiology. In cases of transitional cell carcinoma of the upper urinary tract with diffuse non-papillary carcinoma and/or preoperative positive urine cytology, total nephroureterectomy should be considered.