We reviewed 108 patients with upper urinary tract tumors who underwent surgical treatment during a 10-year period (87 men and 21 women with a mean age of 63.5 years). Of the tumors 97% were unilateral and only 3 patients had bilateral tumors. Two-thirds of the patients had a single tumor focus and a third had 2 or more tumor foci. Additionally, there were 31 patients (28.7%) with previous and/or simultaneous bladder tumors. Nephroureterectomy was performed in 92 cases, nephrectomy in 6 and a conservative operation in 13. In 65 cases lymphadenectomy was added. The survival rates at 5 and 10 years were 67 and 65%, respectively. Of the patients 90% with cancer-related deaths had high grade tumors. Of the 15 patients with positive lymph nodes 87% died of metastasis compared to 8% of the 50 patients with negative lymph nodes. Nine patients (8.7%) had relapse in the upper urinary tract, 6 (5.8%) in the ipsilateral ureter and 3 (2.9%) in the contralateral ureter. Of these 3 patients 2 had recurrent multifocal bladder tumors. For patients who present with an upper urinary tract tumor the risk of a bladder cancer was approximately 9% and that of a contralateral urothelial tumor was 1%.

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The factors which significantly determined if the woman would have seeked medical advice were the need to insert the finger in the vagina to empty the bladder or bowel and the interference of symptoms with physical activities (P<0.05 for all). However, occupation, monthly income, level of education, feeling of vaginal soreness, the awareness of lump or the interference of symptoms with prayers, sexual relationship and social activities did not determine the healthcare-seeking behavior of the affected women (P>0.05 for all).CONCLUSIONS: Symptoms of POP affect the quality of life in the majority of women who are affected by the condition. More than half of them did not seek medical advice. Significant determinants of healthcare-seeking behavior in this condition include the need to insert the finger to empty the bladder or bowel and the interference of symptoms with physical activities.Additional healthcare campaigns addressing these important and sensitive issues are required to educate the public regarding this condition.