Background : The aim of the study presented here was to examine the accuracy of ureteroscopic biopsy in the diagnosis of upper urinary tract transitional cell carcinoma (TCC) and whether nephron-sparing management (holmium YAG laser, transurethral resection or partial ureterectomy) is possible or not based on pathological diagnosis. Methods : Forty consecutive patients underwent ureteroscopic biopsy with the use of 3-Fr cold cup forceps. Pathological diagnosis of the biopsy sample and grade or stage of surgically resected tumors were compared. In patients with grade 1 or 2 TCC diagnosed by ureteroscopic biopsy, the diseasefree and survival rates determined whether nephron-sparing management was performed or not.Results : There were no major complications associated with ureteroscopic biopsy. The pathological grading of the biopsy specimen was almost the same as that of the surgically resected specimen. Eighty five percent of grade 2 or 3 TCC showed muscle invasive disease. There were no significant differences in the disease-free and survival rates between the nephroureterectomy and the nephronsparing management groups, except for grade 3 or pT3 tumors. Conclusion : Ureteroscopic biopsy is safe and accurate if sufficient tissue sample is obtained. Ureteroscopic biopsy should be performed in patients who require nephron-sparing management. Nephroureterectomy can be avoided if the tumor is confirmed as low-grade.

OBJECTIVETo assess the long-term results by symptomatic and radiological outcome of laparoscopic decortication of renal cyst, first reported in 1992. PATIENTS AND METHODSWe retrospectively reviewed the records of 36 patients who had a total of 36 laparoscopic decortications at our institution between December 1993 and March 2004. Of these cysts, 30 were peripheral and six were peripelvic cysts; the patients were asked if they had pain or not. Changes of cyst size after decortication were determined by computed tomography and the serial changes of each cyst were evaluated as the percentage of the diameter before surgery. The relationships between radiological and symptomatic outcome or cyst location were examined. RESULTSPeri-operative morbidity was satisfactory; with a mean (range) follow-up of 67.2 (13-128) months the symptomatic and radiological success rates were 92% (33 of 36) and 81% (25 of 36), respectively. Peripelvic cysts were significantly correlated with radiological failure. Symptomatic improvement was evident by 3 months, while radiological improvement continued for up to 3-4 years after surgery. Seven asymptomatic patients with radiological failure selected a conservative follow-up. CONCLUSIONSLaparoscopic decortication is safe and provides long-term satisfactory symptomatic results. The radiological improvement was slower than the symptomatic improvement and several cysts remained large, indicating some reduction in volume that was enough to improve the symptoms. This procedure is still challenging for peripelvic cysts in terms of radiological results, yet feasible for the clinical outcome.

We report, herein, a case of metastatic renal cell carcinoma of the urinary bladder. A 76-year-old man presented to our hospital. He had undergone right radical nephrectomy at 64 years of age. Cystoscopy revealed a solitary, spherical tumor 1.5 cm in size protruding into the urinary bladder. Transurethral resection was performed and the pathological diagnosis of the lesion was clear cell carcinoma. The patient is alive 12 months after recurrence to the bladder, under the administration of interleukin-2.

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