Stransitional cell carcinoma of the renal pelvis: Radical or conservative surgical treatment?

In the light of the recent controversy over conservative surgical management, the clinical and histologic features in 49 cases of transitional cell carcinoma of the renal pelvis were reviewed. The infrequent occurrence of low grade, noninvasive tumors (8%), the low incidence of bilateral (2%) or asynchronous (8%) development of upper urinary tract lesions, coupled with the high incidence (33%) of ureteral stump recurrences following simple nephrectomy, and the frequent occurrence of invasive lesions (58%), strongly support the traditional doctrine of nephrectomy with total ureterectomy as the treatment of choice for renal pelvic tumors. Local excision is best reserved for rare cases of bilateral disease or when preservation of renal function is mandatory for sustaining life.