Complications Associated With Ureteroscopic Management of Upper Tract Urothelial Carcinoma

Urology. 2021 Jan:147:87-95. doi: 10.1016/j.urology.2020.09.036. Epub 2020 Oct 6.


Objectives: To compile and examine safety data from clinical studies of endoscopic management of patients with low-grade upper tract urothelial carcinoma (UTUC) to identify rates and factors associated with reported complications.

Methods: Ovid Medline and Ovid Medline Daily (with Embase as secondary search) including citations from 1946-2018 were queried using the following terms: ureteroscopy, ureter, catheter, endoscopy, complication, adverse events, morbidity, ablation, laser, upper tract urothelial carcinoma, ureteral stricture, ureteral stenosis, and ureteral injury. Abstracts were reviewed for relevance; diagnostic studies, case studies, and reviews were excluded.

Results: Thirty-eight publications (7 prospective, 31 retrospective) representing >1100 patients were identified. Ureteral stricture was the most frequently reported complication (studies; rates) (26/38; 0-27%), with incidence associated with number of procedures and treatment method. Bleeding, infection, and fever were most common with adjuvant treatment (BCG or mitomycin). Serious and fatal complications were rare.

Conclusions: Ureteral stricture is the most frequent complication of endoscopic UTUC management but can be managed successfully in most cases. Most complications were minor. Although additional prospective studies are needed, these results support the safety of ureteroscopic management of UTUC in appropriately selected patients.

Publication types

  • Review

MeSH terms

  • BCG Vaccine / administration & dosage
  • BCG Vaccine / adverse effects
  • Carcinoma, Transitional Cell / therapy*
  • Chemotherapy, Adjuvant / adverse effects
  • Chemotherapy, Adjuvant / methods
  • Fever / epidemiology
  • Fever / etiology
  • Humans
  • Incidence
  • Kidney Neoplasms / therapy*
  • Mitomycin / administration & dosage
  • Mitomycin / adverse effects
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Prospective Studies
  • Retrospective Studies
  • Treatment Outcome
  • Ureteral Neoplasms / therapy*
  • Ureteral Obstruction / epidemiology
  • Ureteral Obstruction / etiology
  • Ureteroscopy / adverse effects*
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / etiology


  • BCG Vaccine
  • Mitomycin