الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The incidence of upper urothelial neoplasms (UUNs) is about 5% of urinary tract tumors. It’s common in the 6th and 7th decades of life with male predominance. Smoking and exposure to chemical industries are the major risk factors. Hematuria is the most common complaint Other complaints are flank pain , palpable mass and/or systemic symptoms. Most of UUNs are TCC (90% of the cases). SCC and adenocarcinoma account for the remaining 10% of the cases. With recent advancement in both imaging and endoscopic technology, the diagnosis of the UUNs become easier and accurate than before.
Radiologically, tumors of renal pelvis and ureter usually appear as a filling defect in the intrvenous urography with variable degrees of hydronephrosis Other modalities which can used for more evaluation include computerized tomography with contrast or magnetic resonance imaging. Bone scan can be used in cases of suspected distant metastasis. Retrograde pyelography and uretroscopy improve the diagnostic accuracy for UUNs evaluations. Cytology and brush biopsy also are very helpful for diagnosis.
The management of UUNs is complete nephroureterectomy with bladder cuff excision. It’s considered the gold standard for treatment of UUNs with normal contralateral kidney. Laparoscopic nephrouretrectomy has gained its acceptance especially in the last few decades as there was no differences in either cancer specific or crude survival. A nephrosparing approaches have been described for selected patients. With newer technology and better optics, percutancus and ureteroscopic management of UUNs has been described for those selected patients. The benefits of upper tract immunotherapy, adjuvant radiotherapy and chemotherapy are still debated.
After the treatment for UUT-UC, the patient should be kept under strict follow up due to high incidence of bladder recurrence and also ipsilateral recurrence. The treatment outcomes for UUT-UC is generally correlate with tumor stage and grade. The 5-year survival for T1 is 60-90 % and 43-75 % for T2 urothelial tumors after standard open nephroureterectomy and bladder cuff excision