Management of superficial transitional cell carcinoma in the intramural ureter: What to do?

Purpose: We analyze the evolution of superficial transitional cell carcinoma in the intramural distal ureter treated with transurethral resection. Materials and Methods: A total of 19 patients underwent transurethral resection of the intramural distal ureter with a mean followup of 57 months. All cases were diagnosed as superficial transitional cell carcinoma and all but 2 had a history of bladder tumor. Upper urinary tract followup consisted of excretory urography every 6 months and ureterorenoscopy in cases with a doubtful diagnosis or positive cytology. Results: Pathological examination revealed stage Ta disease in 42%, T1 in 31.5% and Tx in 26.3% of intramural tumors. Upper urinary tract recurrence was noted in 8 patients (42.1%), including 5 (62.5%) with involvement of the distal ureter. Nontumoral stenosis of the distal ureter in 3 cases was treated endoscopically. An endoscopic procedure resolved 75% of recurrences. A high surgical risk patient who did not undergo open surgery died of recurrence. Conclusions: Superficial transitional cell carcinoma of the intramural ureter is uncommon in the setting of multiple bladder tumors and recurrent bladder carcinoma. There was a 42.1% rate of ipsilateral recurrence and endoscopic treatment allowed us to preserve 89.5% of the involved renal units. Closer followup of the urinary tract must be performed since these tumors have a higher incidence of upper urinary tract recurrence.