Once the presence of an upper tract tumor has been established, cystoureteroscopy should be performed to examine the entire urine collecting system. A retrograde pyeloureterogram performed during this procedure often reveals a filling defect in the area of the tumor. All abnormal-appearing areas should undergo directed biopsy. The histopathologic findings of upper tract urothelial carcinomas are similar to those of the lower tract and are classified in a similar manner. Once the tumor has been radiographically and pathologically characterized, initial staging can be performed according to TNM criteria.

TREATMENT

Surgery is the therapy for localized disease. The optimal approach depends on characteristics of both the patient and tumor.