Tract Transitional Cell Carcinoma Research Articles

MP-20.06: Bladder Cancer after Managing Upper Urinary Tract Transitional Cell Carcinoma: Incidence and Predictive Factors

MP-20.06: Bladder Cancer after Managing Upper Urinary Tract Transitional Cell Carcinoma: Incidence and Predictive Factors

Multivariate analysis of prognosis of patients with upper urinary tract transitional cell carcinoma

Objective:To retrospectively analyze the clinical data of 71 patients with upper urinary tract transitional cell carcinoma (UUT-TCC), so as to assess the prognosis of patients and search for factors influencing the prognosis of patients. Methods: Totally 71 UUT-TCC patients treated surgically from Feb. 2004 to Jan. 2007 were included in this study. All patients underwent radical nephroureterectomy via retroperitoneoscopic approach or open approach. The patients were followed up once a month after operation. Traditional prognostic factors including age, sex, tumor stage, grade, location, type of surgical treatment and some pathological biomarkers, such as p53, Ki-67, nm23, and C-erB-2, were collected and analyzed with respect to disease-specific survival by Kaplan-Meier method. Predictive factors influencing the disease-specific survival were also analyzed by Cox proportional hazards model. Results: The 1-, 2-or 3-year disease-specific survival rates were 95.8 %, 89.3% and 83.5%, respectively. Only tumor stage was found to be a factor for prognosis by multivariate analysis (P0.001). Conclusion: Tumor stage is an independent predictor of disease-specific survival. Retroperitoneoscopic radical nephroureterectomy achieves similar outcomes to the traditional open surgery on oncology control, with the long-term outcome remains to be further studied.

Significance of ipsilateral renal dysfunction in predicting pathologic stage of upper tract transitional cell carcinoma

Significance of ipsilateral renal dysfunction in predicting pathologic stage of upper tract transitional cell carcinoma

Prognostic Relevance of Prothymosin-α Expression in Human Upper Urinary Tract Transitional Cell Carcinoma

To investigate the prognostic role of prothymosin-alpha (PTMA) expression in human upper urinary tract transitional cell carcinoma (UUT-TCC). Paraffin-embedded tissues were collected from 91 patients with UUT-TCC and from 15 paired normal renal cortex and 13 paired urothelial walls. The primary antibody for PTMA (2F11) used was validated in 4 human urothelial cancer cell lines before assessing the surgical specimen. Immunohistochemistry was then conducted to determine the expression intensity of PTMA, the calculation of immunostaining density using imaging analysis, and for immunostaining localization. The correlates with clinicopathologic characteristics and patient survival were explored. The expression intensity of PTMA demonstrated a significant enhancement of PTMA expression in UUT-TCCs compared with both paired normal tissues (P = .0002 and P = .0004 for UUT-TCC vs the urothelial wall and vs the renal cortex, respectively). As for the localization of PTMA immunoreactivity, of the 91 tumor specimens, 33 (36.3%) were cytoplasmic PTMA-expressing, 51 (56.0%) were nuclear PTMA-expressing, and 7 (7.7%) were PTMA-negative tumors. On univariate and multivariate analyses, PTMA expression localization was the sole independent prognostic indicator for recurrence-free survival (hazard ratio 4.90, 95% confidence interval 1.73-13.9; P = .003), although pathologic staging was an independent prognostic indicator for both progression-free survival (hazard ratio 22.6, 95% confidence interval 2.56-198; P = .005) and disease-specific overall survival (hazard ratio 5.60, 95% confidence interval 1.48-21.2; P = .011). The limitations of our study included small patient numbers and short follow-up. The results of our study have shown that PTMA is overexpressed in UUT-TCCs and that cytoplasmic PTMA expression can provide significant prognostic information for subsequent tumor recurrence in the residual urinary tract after nephroureterectomy.

The Protective Role of Renal Parenchyma as a Barrier to Local Tumor Spread of Upper Tract Transitional Cell Carcinoma and its Impact on Patient Survival

We investigated whether tumor location has independent prognostic significance in upper tract transitional cell carcinoma cases and which factor determines it. We reviewed data on 122 renal pelvis and 102 ureteral tumor cases, including the recurrence pattern. Tumor location and other clinicopathological variables were evaluated regarding cancer specific and recurrence-free survival. Stage pT3 tumors were stratified into those invading renal parenchyma or peripelvic/periureteral fat. Overall 5-year cancer specific survival and recurrence-free survival rates were 77.0% and 71.6%, respectively, at a mean followup of 60.7 months. Of the clinicopathological parameters T stage was the most significant prognosticator of the survival rate, while nodal involvement, high grade and ureteral tumor location were also significant for lower survival rates. Stratification analysis for matching pathological stage revealed that, while survival rates were similar in the renal pelvis and ureteral tumor groups at stage pT2 or less, renal pelvic tumors were associated with significantly higher survival rates than ureteral tumors for stage pT3. Specifically renal pelvic tumors invading the renal parenchyma were associated with a lower local failure rate, and higher cancer specific and recurrence-free survival rates than tumors invading peripelvic or periureteral fat, ie 77.5% vs 49.7% 5-year cancer specific survival and 75.6% vs 32.0% 5-year recurrence-free survival (p = 0.014 and 0.003, respectively). Tumor location is an independent prognostic factor for pT3 upper tract transitional cell carcinoma. The overall better prognosis of renal pelvic tumors was mainly attributable to pT3 tumor outcomes, specifically lesions invading the renal parenchyma. These findings may be due to the protective role of thick renal parenchyma against local tumor spread.

Circumferential Resection of the Inferior Vena Cava for Primary and Recurrent Malignant Tumors

Circumferential vena caval resection is occasionally performed in patients with advanced malignancy. We explored the oncological effectiveness of inferior vena caval resection, as determined by margin status, cancer recurrence and survival. Also, we addressed the morbidity associated with inferior vena caval obstruction and resection, and determined indications for inferior vena caval reconstruction. A total of 18 patients underwent attempted inferior vena caval resection from 1999 to 2008. Primary tumor type was renal cell carcinoma in 7 patients, metastatic testicular cancer in 5, leiomyosarcoma in 3, and adrenal cortical carcinoma, primary retroperitoneal germ cell tumor and upper tract transitional cell carcinoma in 1 each. Data reviewed included preoperative and postoperative sequelae of inferior vena caval obstruction, postoperative complications, pathological results, cancer recurrence, graft requirements and functional outcomes. Mean followup in the entire patient cohort was 24 months. Inferior vena caval resection was completed in 15 of 18 patients, of whom 12 (80%) had negative surgical margins. Of the patients 50% presented with symptoms of venous hypertension, including lower extremity edema with or without venous thrombosis, or abdominal wall varicosity. After inferior vena caval resection symptoms resolved in half of them, likely due to the ongoing formation of collateral vessels. Five asymptomatic patients with incomplete inferior vena caval occlusion underwent reconstruction with inferior vena caval vascular grafts of polytetrafluoroethylene (4) or Dacron (1). The polytetrafluoroethylene grafts remained patent. A total of 12 patients underwent simultaneous nephrectomy and/or left renal vein ligation in the same setting with acceptable alterations in postoperative renal function and no need for permanent dialysis. Cancer recurred locally in 4 of 15 patients who underwent resection. Five of 15 patients in the resection group died of disease or were lost to followup compared to all 3 in whom resection was aborted or macroscopically incomplete (mean followup 19.2 vs 4.3 months). Local cancer control and potentially increased cancer specific survival can be achieved with successful complete circumferential resection of the inferior vena cava as a component of multimodality care in select patients with locally advanced malignancy. Polytetrafluoroethylene is the preferred prosthetic material when inferior vena caval replacement is indicated. The most common postoperative complications are renal insufficiency and lower extremity edema, which are generally transient.

Adjuvant Chemotherapy for High Risk Upper Tract Urothelial Carcinoma: Results From the Upper Tract Urothelial Carcinoma Collaboration

There is relatively little literature on adjuvant chemotherapy after radical nephroureterectomy in patients with upper tract urothelial carcinoma. We determined the incidence of adjuvant chemotherapy in high risk patients and the ensuing effect on overall and cancer specific survival. Using an international collaborative database we identified 1,390 patients who underwent nephroureterectomy for nonmetastatic upper tract urothelial carcinoma between 1992 and 2006. Of these cases 542 (39%) were classified as high risk (pT3N0, pT4N0 and/or lymph node positive). These patients were divided into 2 groups, including those who did and did not receive adjuvant chemotherapy, and stratified by gender, age group, performance status, and tumor grade and stage. Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohorts. Of high risk patients 121 (22%) received adjuvant chemotherapy. Adjuvant chemotherapy was more commonly administered in the context of increased tumor grade and stage (p <0.001). Median survival in the entire cohort was 24 months (range 0 to 231). There was no significant difference in overall or cancer specific survival between patients who did and did not receive adjuvant chemotherapy. However, age, performance status, and tumor grade and stage were significant predictors of overall and cancer specific survival. Adjuvant chemotherapy is infrequently used to treat high risk upper tract urothelial carcinoma after nephroureterectomy. Despite this finding it appears that adjuvant chemotherapy confers minimal impact on overall or cancer specific survival in this group.

The Prognostic Predictors of Primary Ureteral Transitional Cell Carcinoma After Radical Nephroureterectomy

We studied the long-term prognosis, and evaluated the predictors of disease specific and recurrence-free survival in a large cohort of patients who had undergone radical nephroureterectomy for primary transitional cell carcinoma of the ureter. From January 1990 to December 2006, 145 patients with primary ureteral transitional cell carcinoma treated with nephroureterectomy and bladder cuff removal at our institution were included in the study. The medical records of these patients were reviewed retrospectively. The clinical and histopathological data were analyzed to evaluate the prognostic predictive factors. Univariate and multivariate statistical analyses were performed. The 5-year disease specific survival rates of stage pTa/Tis/T1, pT2, pT3 and pT4 were 94.6%, 81.8%, 47.4% and 0%, respectively. The 5-year recurrence-free survival rates according to tumor grade were 68.4% for low grade and 35.7% for high grade disease. Of the 145 patients subsequent bladder tumors developed in 38 (26.2%), local recurrence developed in 11 (7.6%) and metachronous contralateral upper urinary tract tumor developed in 3 (2.1%). Most patients had subsequent tumor recurrence within the first year after radical surgery. On univariate and multivariate analyses tumor stage, tumor grade, severity of chronic renal disease, synchronous bladder tumor and hematuria were the significant prognostic variables predicting disease specific and recurrence-free survival. Advanced tumor and chronic renal disease stages were significantly associated with a worse prognosis in patients with primary ureteral transitional cell carcinoma who had undergone radical nephroureterectomy. With regard to tumor recurrence, advanced tumor stage, high tumor grade and synchronous bladder tumor were independent risk factors.

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Aug 2009Editorial Comment Christopher G. Wood and E. Jason Abel Christopher G. WoodChristopher G. Wood More articles by this author and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.04.146AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 182(2), p. 458 References 1 : Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: time to change the treatment paradigm?. BJU Int2006; 98: 1176. Google Scholar 2 : Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med2003; 349: 859. Google Scholar Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas© 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 182Issue 2August 2009Page: 458 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Christopher G. Wood More articles by this author E. Jason Abel More articles by this author Expand All Advertisement PDF downloadLoading ...

Lasers in percutaneous renal procedures

Since the invention of lasers in 1960, they have been increasingly used in medicine. In this review paper, the types of lasers used in urology, in addition to their applications to percutaneous renal surgery will be reviewed. Specifically, use of lasers in the percutaneous management of renal stones, upper tract transitional cell carcinoma and stricture will be reviewed. Pubmed was searched for citations since 1966. The following terms were used: "lasers", "calculi", "endopyelotomy", and "transitional cell carcinoma". Due to its minimal depth of penetration, holmium laser has proven to be safe and efficacious. It is currently the primary energy source for flexible instrumentation, and also has demonstrated efficacy in percutaneous lithotripsy (faster than ultrasonic lithotripsy and safer than electrohydraulic lithotripsy). Holmium laser been used for antegrade endopyelotomy and percutaneous resection of upper tract transitional cell carcinoma. Holmium laser is safer than other lasers and has become the gold standard for laser lithotripsy for flexible instrumentation. It has been used successfully in the percutaneous management of renal stones, ureteropelvic junction obstruction, and upper tract transitional cell carcinoma. Holmium laser is an alternative energy source to conventional lithotripters and electrocautery for endopyelotomy and resection of upper tract transitional cell carcinoma.

High Incidence of Transitional Cell Carcinoma in Kidney Transplant Recipients in Eastern Taiwan

Objective A higher incidence of urinary tract transitional cell carcinoma (TCC) has been reported in both long-term hemodialysis patients and kidney transplant (KTX) recipients in Taiwan than in other countries. Herein, we report a high incidence of urinary tract malignancy, especially TCC, in KTX recipients in eastern Taiwan. Patients and Methods We retrospectively reviewed the medical records, clinical data, and outcomes of 102 KTX recipients in Tzu Chi General Hospital from 1992 to 2008. Overall graft and patient survival, incidence of posttransplant malignancy, and cumulative incidence of TCC after KTX were investigated. Results During a mean follow-up of 45.5 ± 38.5 months after KTX, 12 malignancies were diagnosed in nine recipients. The incidence of post-transplant malignancy in all recipients was 8.2%. TCC was diagnosed in four patients, and all these patients presented with painless gross hematuria and hydronephrosis. Three patients had tumor involvement in the upper urinary tract. TCC occurred at a mean of 56 ± 70.7 months after KTX, and the cumulative incidence of TCC was 4.7% in the first 3 years after transplant. Only one patient with triple cancer died of disseminated cholangiocarcinoma of the distal common bile duct during a mean follow-up of 15.8 ± 9.5 months after surgical treatment of TCC. Conclusion KTX recipients are at extremely high risk of TCC in eastern Taiwan, with an incidence of 3.9%. The cardinal signs of posttransplant TCC are painless gross hematuria and hydronephrosis of the native kidney. Careful, timely urological screening in KTX recipients warrants early diagnosis and good prognosis after aggressive surgical management.

Patterns of failure and influence of potential prognostic factors after surgery in transitional cell carcinoma of the upper urinary tract

We investigated the long-term outcome of upper urinary tract transitional cell carcinoma (TCC) after surgery. The study population comprised 114 surgically treated patients with upper urinary tract TCC treated at Jikei University Hospital between March 1990 and December 2004. All these patients underwent radical surgery without any type of neoadjuvant therapy. Patterns of failure and patient survival were compared with clinicopathological parameters. The 5- and 10-year overall survival (OAS) rates for the patients were 85% (95% confidence interval [CI], 81%-89%) and 76% (95% CI, 69%-83%). To date, 19 patients (16.7%) have experienced distant or lymph node metastasis at a mean of 13.3 months following surgery (range, 1 to 50 months). The site of the primary tumor did not affect patient survival (P > 0.05). Both lymphovascular involvement (LVI) and positive lymph nodes were found to have poor prognosis in univariate analysis (P = 0.004 and P < 0.0001). Multivariate analysis indicated pathological stage and bladder recurrence (bladder recurrence being a better prognostic factor) to be independent predictors of metastasis-free survival, but not of OAS or cause-specific survival (CSS). Pathological stage and bladder recurrence were found to be the predictors of metastasis-free survival in this study. Further searching for reliable biomarkers is needed to accurately predict the prognosis of this malignancy.

Carcinoma de células transicionales del tracto urinario superior: Opciones de tratamiento actual y abordajes minimamente invasivos

Upper urinary tract transitional cell carcinoma (UUT-TCC) is a rare disease. Open nephroure-terectomy remains the gold standard for surgical treatment. We aim to evaluate the standing of novel surgical treatment in UUT-TCC. Extensive review of available literature on UUT-TCC, with emphasis in surgical treatment. English medical literature available in PubMed, Ovid, EMBASE y Science Direct was employed for the study. Laparoscopic nephroureterectomy, ureteroscopy and percutaneous treatment are the available surgical options that based on adequate patient selection offer acceptable cancer control. Indications for the treatment of UT-TCC are expanding and this allows clinicians to tailor treatment while preserving oncological results.

Imaging and Staging of Transitional Cell Carcinoma: Part 2, Upper Urinary Tract

Transitional cell carcinoma (TCC) of the upper urinary tract is a common malignancy affecting the genitourinary tract. It is commonly multifocal with a high incidence of recurrence requiring rigorous urothelial surveillance. In this article, we discuss the epidemiology, pathologic characteristics, and patterns of tumor spread. We illustrate and discuss the role of imaging in the diagnosis, staging, and surveillance of TCC of the renal pelvis and the ureter. The hallmark of TCC is multiplicity and recurrence. Nearly 2-4% of patients with bladder cancer develop upper tract TCC, but 40% of patients with upper tract TCC develop bladder cancer. Diagnosis of upper tract TCC is heavily dependent on imaging. Understanding the appearances of upper tract TCC on the different imaging techniques used is important in the accurate interpretation of imaging studies. Newer techniques such as CT urography are now increasingly used instead of conventional excretory urography in the surveillance of the upper tract in patients with bladder cancer.

Imaging and Staging of Transitional Cell Carcinoma: Part 1, Lower Urinary Tract

Transitional cell carcinoma (TCC) of the bladder is one of the most common malignancies affecting the genitourinary tract and is characterized by multifocality and a high incidence of recurrence. Radiologists play an important role in the staging and surveillance of this malignancy. In this article, we discuss the epidemiology, pathologic characteristics, and patterns of tumor spread of bladder carcinomas. We illustrate and focus on the role of imaging in the diagnosis, staging, and surveillance of TCC. The hallmark of TCC is multiplicity and recurrence. Cystoscopy is the method of choice for evaluation of the primary tumor in patients with bladder carcinoma. Imaging acts as an adjunct to accurately stage disease in these patients. Nearly 2-4% of patients with bladder cancer develop upper tract TCC. Hence, surveillance of the upper tract, in which imaging plays a central role, is an important component in the management of TCC. As in every other cancer, we face some limitations in nodal staging of TCC, particularly when the nodes are not enlarged. Development and validation of newer scanning techniques and MR contrast agents may help address some of these limitations in the future.

Comparison of Open Nephroureterectomy and Open Conservative Management of Upper Urinary Tract Transitional Cell Carcinoma

Introduction: The treatment preserving the kidney for upper urinary tract (UUT) transitional cell carcinoma (TCC) is still controversial. We aimed to elucidate the results of open conservative surgery and compare them with the results of radical nephroureterectomy (RNU). Patients and Methods: The study included 107 patients with UUT TCC treated by open conservative surgery (21 patients) or nephroureterectomy (86 patients). Epidemiological, clinical and pathological characteristics of patients as well as 5-year survival rates were compared between groups. Results: Patients treated by conservative surgery had a significantly higher rate of bilateral tumors (38% vs. 3%, p = 0.0001) and smaller tumor size than those treated by radical operations (2.60 ± 1.24 vs. 3.99 ± 3.94 cm, p = 0.060). Five-year survival rates for patients treated by conservative and radical surgery were 59 and 55%, respectively. Within the group of patients treated by conservative surgery, 5-year overall survival rates of patients operated due to imperative and elective indications were 41 and 75%, respectively. In univariate analysis, RNU was a statistically significant predictor of poorer outcome of the disease in comparison with conservative surgery (HR = 2.2, 95% CI 1.1–4.6, p = 0.030). Conclusions: The mode of operation affects the outcome of UUT TCC patients, in addition to factors such as tumor grade, stage and size.

Hexylaminolaevulinate ‘blue light’ fluorescence cystoscopy in the investigation of clinically unconfirmed positive urine cytology

To investigate the value of photodynamic diagnosis (PDD) using hexylaminolaevulinate (Hexvix, PhotoCure, Oslo, Norway) in the investigation of patients with positive urine cytology who have no evidence of disease after standard initial investigations. Twenty-three patients referred with positive urine cytology but no current histological evidence of cancer were investigated between April 2005 and January 2007 with PDD, using Hexvix and the D-light system (Karl Storz, Tuttlingen, Germany) to detect fluorescence. The bladder was mapped initially under white light and then under 'blue-light'. Biopsies were taken from abnormal urothelium detected by white light, fluorescence, or both. All cytological specimens were reviewed by a reference cytopathologist unaware of the result of the PDD. Twenty-five PDD-assisted cystoscopies were carried out on 23 patients (20 men/3 women; median age 64 years, range 24-80 years). Of the 23 patients, 17 (74%) were previously untreated for transitional cell carcinoma (TCC), whilst six were under surveillance for previous TCC. Nineteen of the 23 (83%) cytology specimens were confirmed as suspicious or positive by the reference pathologist. TCC of the bladder or preneoplastic lesions were diagnosed in six patients, i.e. six (26%) of those investigated and six of 19 (32%) with confirmed positive cytology. Four of the six were under surveillance for previous bladder tumour. Additional pathology was detected by fluorescence in five of the six patients, including two carcinoma in situ (CIS), one CIS + G3pT1 tumour, and two dysplasia. Diagnoses in PDD-negative cases included one upper tract TCC and four patients with stones. In addition, one patient had CIS diagnosed on both white light and PDD 6 months later. Additional pathology was detected by HAL fluorescence cystoscopy in 32% of patients with confirmed positive urinary cytology. PDD is a key step in the management of patients with positive urinary cytology and no evidence of disease on conventional tests.

Bacillus Calmette-Guérin for Upper Tract Urothelial Cancer: Is There a Role?

Since the first reported case of using adjuvant topical immunotherapy utilizing bacillus Calmette-Guérin (BCG) was published by Herr and associates, several institutions have utilized numerous agents for topical infusion therapies (BCG, Mitomycin, Epirubicin, Thiotepa or combination therapy of BCG/INF) as adjuncts in the treatment of upper tract papillary transitional cell carcinoma. A comprehensive review of the current data in the treatment of upper tract transitional cell carcinoma (Ta/T1 disease) with adjuvant BCG therapy was completed. Currently, the efficacy of adjuvant BCG therapy was not demonstrated.

Commentary on Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: Oncological outcomes at 7 years

We present long-term oncological outcomes following laparoscopic nephroureterectomy for upper tract transitional cell carcinoma. Between December 1997 and August 2005, 100 patients underwent laparoscopic nephroureterectomy for upper tract transitional cell carcinoma at our institution. Data were obtained from a prospectively maintained database, patient charts, telephone follow-up, and a review of the Social Security Death Index. Median patient age at surgery was 73 years. Final pathological stage was pTis/pTa in 28% of patients, pT1 in 31%, pT2 in 13%, pT3 in 24%, and pT4 in 4%. High grade lesions were present in 58% of patients, multifocal disease was present in 23%, and lymphovascular invasion was present in 9%. Positive surgical margins occurred in 7 patients (7%). Median follow-up was 7 years (range 2–10). At 2, 5, and 7 years, overall survival was 81%, 59%, and 50%, cancer specific survival was 91%, 77%, and 72%, and recurrence-free survival was 66%, 50%, and 36%, respectively. Five-year cancer specific survival by stage was 80% for pTis/Ta, 70% for pT1, 68% for pT2, 60% for pT3, and 0% for pT4. On univariate analysis non-organ confined disease and lymphovascular invasion affected cancer specific survival ( P = 0.01 and 0.04, respectively). On multivariate analysis only non-organ confined disease was a significant factor ( P = 0.04). Concomitant bladder tumor at diagnosis was associated with poor recurrence-free survival on univariate and multivariate analysis ( P = 0.02 and 0.01, respectively). To our knowledge, the largest long-term follow-up after laparoscopic nephroureterectomy for upper tract transitional cell carcinoma is presented. Long-term oncological outcomes appear comparable to those of open surgery.

What Is the Cost of Maintaining a Kidney in Upper-Tract Transitional-Cell Carcinoma? An Objective Analysis of Cost and Survival

For many years, the gold standard in upper urinary tract transitional-cell carcinoma (UT-TCC) management has been nephroureterectomy with excision of the bladder cuff. Advances in endourologic instrumentation have allowed urologists to manage this malignancy. The feasibility and success of conservative measures for UT-TCC have been widely published, but there has not been an objective cost analysis performed to date. Our goal was to examine the direct costs of renal-sparing conservative measures v nephroureterectomy and subsequent chronic kidney disease (CKD) or end-stage renal disease (ESRD). Secondary analysis includes a discussion of survival and quality-of-life issues for both treatment cohorts. Retrospective review of a cohort of patients treated at our institution with renal-sparing ureteroscopic management of UT-TCC who were followed for a minimum of 2 years. The costs per case were based on equipment, anesthesia, surgeon fees, pathologic evaluation fees, and hospital stay. ESRD and CKD costs were estimated based on published reports. From 1996 to 2006, 254 patients were evaluated and treated for UT-TCC at our institution. A cohort of 57 patients was examined who had a minimum follow-up period of 2 years. Renal preservation in our series approached 81%, with cancer-specific survival of 94.7%. Assuming a worst-case scenario of a solitary kidney with recurrences at each follow-up for 5 years v nephroureterectomy and dialysis for the same period, an estimated $252,272 U.S. dollars would be saved. This savings would cover the expenses of five cadaveric renal transplantations. Conservative endoscopic management of UT-TCC in our experience should be the gold standard management for low-grade and superficial-stage disease. From a cost perspective, renal-sparing UT-TCC management is effective in reducing ESRD health care expenses.