Does flexible ureteropyeloscopy promote local recurrence of transitional cell carcinoma?

Ureteropyeloscopy has gained increasing acceptance as an initial method of diagnosis, treatment, and surveillance of upper tract hematuria and radiographically demonstrated filling defects. With its more frequent use, concern for the possibility of migration of malignant cells during endoscopy secondary to increased intrarenal pressure must be addressed. We report on 13 patients, all of whom underwent ureteropyeloscopy with biopsy and treatment one to four times prior to nephroureterectomy for transitional cell carcinoma of the renal pelvis. Only one patients had vascular/lymphatic extension, and because of the tumor growth characteristics, extension was suspected prior to endoscopy. This patient had no free cells or clumps noted. There have been no local recurrences in the follow-up of 3 months to 6 years. We believe uretero pyeloscopy to be safe and effective for endoscopic diagnosis and treatment of upper tract neoplasm.