Nephroureterectomy with excision of a bladder cuff has been the standard form of treatment of upper urinary tract transitional cell carcinoma (TCC) since it was established by Kimball and Ferris in 1934.<sup>42 Kimball F.N., Ferris H.W. Papillomatous tumor of the renal pelvis associated with similar tumors of the ureter and bladder: Review of the literature and report of two cases J Urol 1934 ;  31 : 257

Cliccare qui per andare alla sezione Riferimenti</sup> Any technique that is short of total extirpation of the involved upper tract was considered to expose the patient to cancer-related risks because of the multifocality and the high recurrence rate of these tumors.<sup>31 Hetherington J.W., Ewing R., Philp N.H. Modified nephroureterectomy: A risk of tumor implantation Br J Urol 1986 ;  58 : 368  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 80 Streem S.B. Percutaneous management of upper tract transitional cell carcinoma Urol Clin North Am 1995 ;  22 : 221

Cliccare qui per andare alla sezione Riferimenti</sup> As many as two thirds of ureteropelvic tumors may show certain degrees of multiplicity, and less radical surgeries may end up with a urothelial recurrence rate of more than 65%.<sup>2 Auld C.D., Grigor K.M., Fowler J.W. Histopathological review of transitional cell carcinoma of the upper urinary tract Br J Urol 1984 ;  56 : 485

Cliccare qui per andare alla sezione Riferimenti, 48 Mazeman E. Les tumeurs de la voie exctrétrice urinaire superieure: Rapport. Association Française d'Urologie, 66th Session, Paris, 121–135, 1972.

Cliccare qui per andare alla sezione Riferimenti</sup> The radical attitude was justified further by the low incidence of bilateral tumors (< 5%) and the limitations of upper tract endoscopic control.<sup>12 Charbit L., Gendreau M.-C., Mee S. , e al. Tumors of the upper urinary tract: Ten years of experience J Urol 1991 ;  146 : 1243

Cliccare qui per andare alla sezione Riferimenti, 26 Hall C.M., Womack S., Sagalowsky A.I. , e al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: A 30-year experience in 252 patients Urology 1998 ;  52 : 594  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 44 Latham H.S., Kay S. Malignant tumors of the renal pelvis Surg Gynecol Obstet 1974 ;  138 : 613

Cliccare qui per andare alla sezione Riferimenti, 77 Shinka T., Uekado Y., Aoshi H. , e al. Occurrence of uroepithelial tumors of the upper urinary tract after the initial diagnosis of bladder cancer J Urol 1988 ;  140 : 745

Cliccare qui per andare alla sezione Riferimenti</sup>

Nephroureterectomy, however, is a major operation that may not be tolerated by many patients in the age range in which upper tract TCC is most common (60–80 years of age).<sup>16 Cummings K.B., Correa R.J., Gibbons R.P. , e al. Renal pelvic tumors J Urol 1975 ;  113 : 158

Cliccare qui per andare alla sezione Riferimenti</sup> The extent of its standard incision also cannot be minimized without compromising its efficiency.<sup>43 Krogli J., Kvist E., Rye B. Transitional cell carcinoma of the upper urinary tract: Prognostic variables and postoperative recurrences Br J Urol 1991 ;  67 : 32

Cliccare qui per andare alla sezione Riferimenti, 46 Marshall F.F., Walsh P.C. In situ management of renal tumors: Renal cell carcinoma and transitional cell carcinoma J Urol 1984 ;  131 : 1045

Cliccare qui per andare alla sezione Riferimenti, 87 Wallace B.M.A., Walace D.M., Whitfield H.N. , e al. The late results of conservative surgery for upper tract urothelial carcinomas Br J Urol 1981 ;  53 : 537  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 91 Ziegelbaum M., Novick A.C., Streem S.B. , e al. Conservative surgery for transitional cell carcinoma of the renal pelvis J Urol 1987 ;  138 : 1146

Cliccare qui per andare alla sezione Riferimenti</sup> Trying to simplify the technique by resecting the ureteral orifice and pulling on the ureter from a single loin incision has been associated with a significant rate of recurrences at the site of the resected orifice.<sup>31 Hetherington J.W., Ewing R., Philp N.H. Modified nephroureterectomy: A risk of tumor implantation Br J Urol 1986 ;  58 : 368  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> A bigger dilemma was faced when dealing with patients with solitary kidneys—congenital or by a previous nephrectomy—with compromised renal function, or with bilateral urothelial tumors.<sup>10 Bouffioux Ch., Adrianne R., Bonnet P. , e al. The experience of the CHU Liège with conservative surgery in the management of upper urinary tract tumors Acta Urol Belg 1994 ;  62 : 39

Cliccare qui per andare alla sezione Riferimenti</sup> Nephroureterectomy in these patients would result in an anatomic or functional anephric state, leading to chronic hemodialysis.<sup>80 Streem S.B. Percutaneous management of upper tract transitional cell carcinoma Urol Clin North Am 1995 ;  22 : 221

Cliccare qui per andare alla sezione Riferimenti</sup> Long-term hemodialysis is associated with significant morbidity and mortality, with a 5-year survival rate of only 19% in patients 65 to 74 years old.<sup>27 Held P.J., Brunner F., Odaka M. , e al. Five-year survival for end-stage renal disease patients in the United States, Europe, and Japan: 1982 to 1987 Am J Kidney Dis 1990 ;  15 : 451

Cliccare qui per andare alla sezione Riferimenti</sup> Although the incidence of bilateral TCC is generally low, Balkan nephropathy and occupational exposures are associated more commonly with multiple and bilateral upper urinary tract TCC than are tumors with other causes.<sup>50 Messing E.M., Catalona W. Urothelial tumors of the renal pelvis and ureter Campbell's Urology Philadelphia: WB Saunders (1998).  2383-2394

Cliccare qui per andare alla sezione Riferimenti, 89 Wong-You-Cheong J.J., Wagner B.J., Davis C.J. Transitional cell carcinoma of the urinary tract: Radiologic–pathologic correlation Radiographics 1998 ;  18 : 123

Cliccare qui per andare alla sezione Riferimenti</sup> Balkan nephropathy also is accompanied by a certain degree of renal impairment, and urothelial tumors associated with it are generally of low grade and exhibit an indolent behavior.<sup>65 Radovanovic Z., Krajinovic S., Jankovic S. , e al. Family history of cancer among cases of upper urothelial tumors in the Balkan nephropathy area J Cancer Res Clin Oncol 1985 ;  110 : 181

Cliccare qui per andare alla sezione Riferimenti</sup> The previously mentioned circumstances and the possible need for nephrotoxic chemotherapy to control advanced disease raised a big question about how necessary and vital it is to treat every filling defect of the upper urinary system with nephroureterectomy, especially because 50% to 82% of upper tract tumors treated with nephroureterectomy in the different series were low-stage and low-grade (GI-II, Ta-T1).<sup>12 Charbit L., Gendreau M.-C., Mee S. , e al. Tumors of the upper urinary tract: Ten years of experience J Urol 1991 ;  146 : 1243

Cliccare qui per andare alla sezione Riferimenti, 14 Corrado F., Ferri C., Mannini D. , e al. Transitional cell carcinoma of the upper urinary tract: Evaluation of prognostic factors by histopathology and flow cytometric analysis J Urol 1991 ;  145 : 1159

Cliccare qui per andare alla sezione Riferimenti, 15 Cummings K.B. Nephroureterectomy: Rationale in the management of transitional cell carcinoma of the upper urinary tract Urol Clin North Am 1980 ;  7 : 569

Cliccare qui per andare alla sezione Riferimenti, 48 Mazeman E. Les tumeurs de la voie exctrétrice urinaire superieure: Rapport. Association Française d'Urologie, 66th Session, Paris, 121–135, 1972.

Cliccare qui per andare alla sezione Riferimenti, 57 Nocks B.N., Heney N.M., Daly J.J. , e al. Transitional cell carcinoma of the renal pelvis Urology 1982 ;  19 : 472  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 69 Rubenstein M.A., Walz B.J., Bucy J.G. Transitional cell carcinoma of the kidney: Twenty-five–year experience J Urol 1978 ;  119 : 594

Cliccare qui per andare alla sezione Riferimenti</sup> The behavior of such tumors is usually indolent, and the risk for invasiveness and metastasis is low.<sup>35 Irwin R., Zincke H., Droller M. , e al. Treatment modalities in superficial bladder cancer Semin Urol 1989 ;  7 (suppl 1) : 3

Cliccare qui per andare alla sezione Riferimenti, 37 Jones P.A., Droller M.J. Pathways of development and progression in bladder cancer: New correlations between clinical observations and molecular mechanisms Semin Urol 1993 ;  11 : 177

Cliccare qui per andare alla sezione Riferimenti, 56 Newman L.H., Tannenbaum M., Droller M.J. Muscle invasive bladder cancer: Does it arise de novo or from pre-existing superficial disease? Urology 1988 ;  32 : 58  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 57 Nocks B.N., Heney N.M., Daly J.J. , e al. Transitional cell carcinoma of the renal pelvis Urology 1982 ;  19 : 472  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup>