Transitional cell carcinoma of the renal pelvis and ureter

Urinary System Anatomy
Urinary System Anatomy
Transitional cell carcinoma is cancer of the urothelium, the lining of the urinary tract.  In the bladder this cancer is referred to as bladder cancer.  When it occurs in the ureter or renal pelvis it is caller upper tract transitional cell carcinoma (UT-TCC). These cancers are rare compared to bladder cancer.  In certain instances they can be treated endoscopically with ureteroscopic fulguration or laser ablation.  More commonly they require surgical removal.  Surgery may precede or follow systemic chemotherapy.  When UT-TCC occurs in the lower part of the ureter near the bladder, it may be possible to remove only the affected part of the ureter (distal ureterectomy).  Likewise UT-TCC in the middle or upper ureter may possibly be treated with subtotal or total ureterectomy.  All these approaches require urinary tract reconstruction consisting of ureteral reimplantation, with or without a psoas hitch, Boari flap, ileal ureter, or autotransplantation of the kidney.  When UT-TCC affects the renal pelvis or calyces of the kidney and endoscopic treatment is not indicated or possible, then kidney and ureteral removal is required.  This surgery is called nephroureterectomy and entails removal of the entire kidney and ureter in one piece (en bloc) as well as a small portion of the bladder (bladder cuff).  This surgery can be performed via a laparoscopic or robotic approach much the same way as a radical nephrectomy.  See Robotic Nephroureterectomy and Robotic Upper Urinary Tract Reconstruction for more information.