Jozef Marenčák
Upper urinary tract urothelial carcinoma (UUTUC) is relatively uncommon and comprises 5 – 10 % of all urothelial tumours. Aetiology and natural history of upper urinary tract urothelial carcinoma are similar to that of urothelial cell carcinomas in the bladder. Histologically, the most renal pelvic and ureteral cancers are transitional cell carcinomas. There are risk factors, including environmental and genetic risk factors. A most common symptom of upper urinary tract urothelial carcinoma is haematuria, either gross or microscopic (70 – 80 %), flank pain (in 20 % of tumours) and a lumbar mass (present in approximately 10 %). CT urography has become the imaging modality of choice for evaluation the presence and extent of urothelial carcinoma of the renal pelvis and/or ureter. Advancements in endoscopic techniques have aided in the diagnosis, grading and treatment of this disease. Treatment options include many modalities. The gold standard surgical management is radical nephroureterectomy with excision of bladder cuff, which is increasingly being performed laparoscopically or robotically with various methods used for distal ureter. There are increasing numbers of patients being treated endoscopically, with excellent oncological outcomes in low (favourable) grade disease. The use of topical chemotherapy agents has been extrapolated from bladder cancer and may be an adjunct to endoscopic management in those patients in whom it is imperative to avoid radical nephroureterectomy.