Efficacy and safety of onabotulinum toxin A for overactive bladder

Overactive bladder(OAB) syndrome is a condition which affects 16.9% of women and 16.2% of men with a significant negative impact on quality of life. It is a condition characterized by urgency, with or without urge incontinence, frequency and nocturia. Behavioral modifications and oral anti-muscurinic medications are first and second-line therapies for OAB but are frequently ineffective or poorly tolerated. For refractory cases of OAB, onabotulinum toxin can be offered and this therapy was approved by the Food and Drug Administration in January of 2013. In this editorial, we will review the indications, usage, efficacy and safety data for intradetrusor injection of onabotulinum toxin A.

From the battlefield to the bladder: The development of thio TEPA

Effective medications for the treatment of cancer were nonexistent in the early twentieth century.Ironically the widespread use of toxic chemical weapons,chlorine and sulfur mustard gas,during the"Great War"led to the first successful chemotherapeutic treatment of cancer patients.Soon after the introduction of poisonous gas on the battlefield,reports of the resulting pancytopenia in exposed combatants appeared in the medical literature.The biologic effect of chemical weaponry on rapidly dividing cells eventually was recognized for its salutary potential in the treatment of cancer.Once this potential was appreciated,hundreds of similar compounds were synthesized and evaluated as chemotherapeutic agents.One such compound,thioT EPA,would eventually open the era of intravesical treatment of urothelial cancer.

Laparoscopic single site surgery: Experience in pediatric urology

Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on the current status and future prospects for LESS in pediatric urology, with special emphasis on our experience with LESS in children. The clinical data available clearly demonstrate that LESS can safely and effectively be performed in a variety of pediatric urology settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low; mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains improved cosmetic outcome. Prospective randomized studies are awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technological advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics may be a driving force in the development of LESS.

Preclinical therapy of benign prostatic hyperplasia with neuropeptide hormone antagonists

Benign prostatic hyperplasia(BPH)is a pathologic condition of the prostate described as a substantial increase in its number of epithelial and stromal cells.BPH may significantly reduce the quality of life due to the initiation of bladder outlet obstruction and lower urinary tract syndromes.Current medical therapies mostly consist of inhibitors of 5α-reductase orα1-adrenergic blockers;their efficacy is often insufficient.Antagonistic analogs of neuropeptide hormones are novel candidates for the management of BPH.At first,antagonists of luteinizing hormone-releasing hormone(LHRH)have been introduced to the therapy aimed to reduce serum testosterone levels.However,they have also been found to produce an inhibitory activity on local LHRH receptors in the prostate as well as impotence and other related side effects.Since then,several preclinical and clinical studies reported the favorable effects of LHRH antagonists in BPH.In contrast,antagonists of growth hormone-releasing hormone(GHRH)and gastrin-releasing peptide(GRP)have been tested only in preclinical settings and produce significant reduction in prostate size in experimental models of BPH.They act at least in part,by blocking the action of respective ligands produced locally on prostates through their respective receptors in the prostate,and by inhibition of autocrine insulin-like growth factors-Ⅰ/Ⅱand epidermal growth factor production.GHRH and LHRH antagonists were also tested in combination resulting in a cumulative effect that was greater than that of each alone.This article will review the numerous studies that demonstrate the beneficial effects of antagonistic analogs of LHRH,GHRH and GRP in BPH,as well as suggesting a potential role for somatostatin analogs in experimental therapies.

Metabolic syndrome in the development and progression of prostate cancer

Prostate cancer(PCa)is the most common noncutaneous malignancy and second leading cause of cancerspecific mortality for men in the United States.There is a wide spectrum of aggressiveness ranging from biologically significant to indolent disease,which has led to an interest in the identification of risk factors for its development and progression.Emerging evidence has suggested an association between metabolic syndrome(MetS)and PCa.MetS represents a cluster of metabolic derangements that confer an increased risk of cardiovascular disease and type 2 diabetes mellitus.Its individual components include obesity,dyslipidemias,high blood pressure,and high fasting glucose levels.Met S has become pervasive and is currently associated with a high socioeconomic cost in both industrialized and developing countries throughout the world.The relationship between MetS and PCa is complex and yet to be fully defined.A better understanding of this relationship will facilitate the development of novel therapeutic targets for the prevention of PCa and improvement of outcomes among diagnosed men in the future.In this review,we evaluate the current evidence on the role of MetS in the development and progression of PCa.We also discuss the clinical implications on the manage-ment of PCa and consider the future direction of this subject.

Recirculating chemohyperthermia as a treatment for non-muscle invasive bladder cancer:Current and future perspectives

About 75% of all bladder cancer diagnosed are non-muscle invasive bladder cancer(NMIBC), recurring over 50% of them after transurethral resection of the bladder tumor. In order to prevent recurrences, adjuvant intravesical chemotherapy with mitomycin C and immunotherapy with bacillus Calmette-Gu-érin(BCG) is traditionally used. Unfortunately, many patients relapse after receiving these treatments and a significant proportion of them require surgery. After a one-to-three years BCG maintenance, the risk for progression at 5 years was 19.3% for T1G3 tumors. Many new treatment approaches are being investigated to increase the effectiveness of adjuvant intravesical therapy. One of the developing treatments for intermediate and high-risk NMIBC is the combination of intravesical chemotherapy and hyperthermia, called chemohyperthermia. This article provides a review of the mechanism of action, current status and indications, results and future perspectives.

Pre-transplant treatment of large polycystic kidney

AIM: To evaluate the indications, optimal timing andoutcomes of native nephrectomy and other techniques in pretransplant treatment of autosomal dominant polycystic kidney disease(PKD).METHODS: A literature review was conducted using the Pub Med and Epistemonikos databases. Keywords for pre-transplant surgical management of polycystic kidneys were: Transplant, treatment and PKD. Keywords for pre-treatment embolization of PKD were: Embolization, transplant and polycystic kidney disease. The inclusion criterions were all articles found using this search method. The exclusion criterions were articles found to include bias and not attending pre-transplant treatment options. Fifteen articles were included in our final analysis. Ten articles were found regarding embolization of PKD of which three reviews were selected for final analysis. The reviews were divided into pre transplant and intra transplant treatment for the surgical treatment of PKD. All articles meeting inclusion criteria were thoroughly analyzed by two independent reviewers. A third independent reviewer was consulted if the reviewers did not agree upon the inclusion or exclusion of a specific article. No statistical analysis was performed.RESULTS: Studies vary regarding the technique used(open or laparoscopic), laterality(single or bilateral) and temporality of nephrectomy with respect to renal transplant(pre-transplant or simultaneous to transplant). Several groups argue in favor of simultaneous nephrectomy and kidney transplant since it avoids the deleterious effects of being anefric. Long-term results and patient satisfaction are acceptable. However, it is associated with increased operative time, transfusion rate, morbidity and length of hospital stay. Based on small sample studies, bilateral nephrectomy prior to transplant has been associated with a higher risk of morbidity and mortality. Studies on laparoscopic approach report it as a feasible and safe alternative to the open surgery approach, highlighting its lower complication rate, transfusions and shorter hospital stay. Arterial embolization of the kidney appears as an effectiveand low morbid alternative for the management of large native kidneys. The reduction in renal size allow transplant in a significant number of patients, which makes it an appealing alternative to surgery.CONCLUSION: There is limited evidence regarding best pretrasnplant treatment of large PKD but to date embolization seems an appealing alternative to augment space for renal graft allocation.

Genetics and male infertility

The goal of this review is to explain the requirement for understanding the genetic structure of infertility arising from male factor and to discuss the essentials of these genetic elements(2). The majority of the population is affected by this disorder caused by male factor infertility(1); but the etiologies are still unknown. After the primary genetic structure in infertile phenotypes is searched, an evaluation can be made. Thus the reasons causing infertility can be discovered and patients can benefit from effective therapies(1). Publications about male infertility within the recent 10 years in the Pubmed database were discussed(1). There are some approachments for describing the function of specificgenes, but no adequate study is present to be useful for diagnosing and treating male infertility(1). Male fertility and fertility in offspring of males are considerably affected by the exact transition of epigenetic information(1). When the genetic factors playing a role in male infertility were analysed, significant steps will be taken for treating patients and determining the reasons of idiopathic infertility(1). Developments in technology associated with the impact of genetics may enable to specify the etiology of male infertility by determining specific infertile phenotype marks(1).

Alternative mechanisms for prostate-specific antigen elevation:A prospective analysis of 222 transurethral resections of prostate patients

AIM: To investigate the relationship between prostatespecific antigen(PSA) levels and(1) bladder outlet obstruction(BOO) and(2) the severity of prostate inflammation.METHODS: Two hundred and twenty-two consecutive patients undergoing transurethral resection of the prostate(TURP) were prospectively included. Patients with proven urinary tract infection and/or known prostate cancer were excluded. PSA levels, International Prostate Symptoms Score(IPSS), prostate weight, post residual volume and pressure flow parameters were determined. A histopathological assessment of the presence and severity of inflammation was also performed.RESULTS: Patients had a mean age of 69.1 ± 8.6 years(45-90 years), with mean preoperative PSA levels of 4.7 ± 5.4 ng/m L(0.2-32.5 ng/m L) and IPSS of 15.7 ± 6.9(0-32). Mean Pdet Q max was 96.3 ± 34.4 cm H2O(10-220 cm H2O). The mean resected prostate weight was 39.4 ± 27.3 g(3-189 g). Correlations were observed between PSA(logarithmic) and resected prostate weight(r = 0.54; P < 0.001), PSA(logarithmic) and Pdet Q max(r = 0.17; P = 0.032), and resected prostate weight and Pdet Q max(r = 0.39; P < 0.001). Furthermore, low correlations were observed between PSA(logarithmic) and active(r = 0.21; P < 0.0001) and chronic(r = 0.19; P = 0.005) inflammation. CONCLUSION: In this study we showed a correlation between BOO(Pdet Q max) and PSA(logarithmic). Furthermore, we demonstrated a weak correlation between PSA(logarithmic) and active as well as chronic prostatic inflammation.

Case of intramedullary spinal cord metastasis of renal cell carcinoma

Intramedullary spinal cord tumors are rare. The improved survival resulting from more effective treatments formany cancers has led to an increased number of publications concerning intramedullary spinal cord metastasis(ISCM), including case reports and literature reviews; however, ISCM remains extremely rare in renal cancer. A 69-year-old man with a medical history of renal cell carcinoma(RCC) presented with urinary retention and bilateral paralysis of the lower extremities. A neurological examination revealed bilateral paraparesis below L1. Although brain magnetic resonance imaging(MRI), bone scintigraphy, and abdominal contrast-enhanced computed tomography revealed no abdominal findings, the thracolumbar MRI indicated a spot on the spinal cord at the Th12 level that exhibited hyperintensity on T2-weighted imaging and gadolinium diethylenetriaminepentaacetic acid enhancement on T1-weighted imaging. Accordingly, an ISCM of RCC was diagnosed. The patient rejected all treatments for these metastases except the steroid therapy. The patient's condition deteriorated owing to metastatic progression, and he died 3 mo after the appearance of ISCM symptoms. The prognosis of this condition was poor. The mean survival durations were 8 mo with surgical treatment, 4 mo with irradiation, and 2 mo with palliative treatments. In cases involving neurological features and if brain or bone metastasis or spinal cord compression is not clearly observed, gadolinium-enhanced MRI should be performed to determine the existence of ISCM. Recently, some authors have reported the efficacy of ISCM resection. Surgical treatment could potentially yield improvements in the nervous symptoms or a longer survival after treatment. Although the prognosis was poor in most cases of ISCM, surgical treatment may improve the patient's quality of life.

Barbed polyglyconate vs monocryl suture in vesico-urethral anastomosis during robot-assisted radical prostatectomy

AIM: To compare outcomes using barbed polyglyconate(V-Loc 180) vs monofilament monocryl suture in forming vesico-urethral anastomosis(VUA) during robot assisted radical prostatectomy.METHODS: Review of prospectively collected robot assisted radical prostatectomy data between July 2011 and September 2012. VUA technique: VUA was performed using 2 cm × 15 cm 2/0 V-Loc 180 continuous sutures or 3/0 monofilament monocryl sutures. Anastomotic integrity was tested intra-operatively with a water leak test. All patients had a post-operative cystogram at day 7 to 10.RESULTS: There were 189 patients in the study with 113 in the V-Loc group and 76 in the monocryl group. Demographics were similar for both groups P > 0.05). The median operative time for V-Loc group was 130 min and monocryl group was 145 min, which was statistically significant(P < 0.001). The median blood loss for both groups was 200 m L with no significant difference(P = 0.260). The pathology results of the 2 groups were similar(P = 0.537). Four patients in the V-Loc group and two patients in the monocryl group had radiological urinary leak. This was not statistically significant(P = 1.00) and all patients improved with conservative management. The continence rates were comparable for both groups.CONCLUSION: V-Loc suture significantly reduced operative time facilitating ease of VUA formation. Overall functional outcome and urinary morbidity were not significantly different from the monofilament group.

Value of preoperative MRI for prostate cancer staging and continence outcomes prior to prostatectomy: A review of the literature

Pelvic imaging in newly diagnosed prostate cancer is primarily used for staging prior to definitive treatment. Over the past decade use of magnetic resonance imaging(MRI) for pre-surgical planning has increased, as well has he technology and methods for performing prostate MRI. To investigate and define the different MRI technologies available and further assess MRI technology ability to predict pathologic stage. Searching Pub Med, we identified current published literature,where the cohort population underwent pre-operative MRI followed by prostatectomy. Keywords used in the Pub Med literature search included: MRI, prostate cancer, prostate cancer staging, multiparamentric MRI and incontinence. Papers were included for review if they discussed use of MRI prior to prostatectomy and had corresponding pathologic data, staging, incontinence, and surgical outcomes. Primary information noted was MRI sensitivity, specificity and overall accuracy for detecting extracapsular extension(ECE) and seminal vesicle involvement(SVI). Secondary information derived included assessing the surgical influence of staging information, and identifying predictors of urinary incontinence recovery. Review of the literature showed that in regards to extracapsular extension the reported MRI accuracy ranged from 76%-98%, sensitivity from 20%-90% and specificity from 82%-99%. As for seminal vesicle involvement the reported MRI accuracy ranged from 76%-98%, sensitivity from 20%-90% and specificity from 82%-99%. There is a widely varying sensitivity and specificity for both ECE and SVI and the wide variability in the MRI technology used in the literature supports that use of MRI technology for prostate cancer remains investigational.

Vasectomy reversal: A review of the evaluation, techniques, and outcomes

This review highlights the evaluation and treatment of men who have undergone vasectomy and desire vasectomy reversal to father children. For surgeons offering this treatment, the appropriate evaluation and treatment are crucial for acceptable outcomes. Although variations on surgical approaches have evolved over the years, one constant is the need for a high level o training and skill in microsurgical techniques.

Functional and metabolic complications of androgen deprivation therapy

Prostate cancer is the most common non-cutaneous cancer in men worldwide.Several different treatment strategies are available including minimally invasive procedures for localized tumors such as radical prostatectomy,radiotherapy,and androgen deprivation therapy,among others.All these strategies can be given as mono-therapy or as combination therapy.For this review,we will focus on the side effects of androgen deprivation therapy,independent of the other treatment modalities.Some of the most common affections are loss of bone mineral density,weight gain and obesity,myocardial infarction and sudden death,metabolic syndrome and insulin resistance,dyslipidemia,loss of libido and erectile dysfunction,fatigue,cognitive decline,vasomotor flushing,to mention a few.All these alterations can have an impact on quality of life and even lead to more serious complications such as fractures and cardiovascular complications.We present recommendations for prevention,early recognition and treatment.The different modalities for androgen deprivation therapy have particular side-effects profiles and indications should be made in an individualized manner.Androgen deprivation therapy is a useful tool for some patients with prostate cancer but every effort should be made to avoid related complications.The use of guidelines and educational programs for both,patients and urologists,are extremely useful strategies.

Update summarising the conclusions of the international consultation on male lower urinary tract symptoms

The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms(LUTS). In this review, we summarise the conclusions from fourof the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life(Qo L) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and Qo L available to men with LUTS. Metaanalyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume > 30 mL, PSA > 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.

Potential of metastin and metastin receptor as biomarkers for urological cancers

AIM: To investigate the current state of the research of metastin and metastin receptor in the urological cancer field.METHODS: For analyzing the value of metastin and metastin receptor as molecular biomarkers for the patients with urological cancer, MEDLINE database searches were performed using these terms: metastin, KISS1, kisspeptin, renal(cell) carcinoma(RCC), kidney cancer or urothelial cancer or bladder cancer or prostate cancer or testicular cancer(tumor). Since the articles were evaluated by the validity of the articlesbased on plausibility, credibility, and evidence levels, the articles were graded according to their level of evidence, using the grading system defined by the Oxford Centre for Evidence-based Medicine. RESULTS: A total of six clinical studies published by individual institutions between 2003 and 2013 were included in this review. The article numbers for each of the evidence levels 2a and 2b were three(50%) and three(50%), respectively. Immunohistochemistry and reverse transcriptase-polymerase chain reaction using tumor tissues were performed to analyze in five articles(83%) and in one article(17%). The value of metastin and/or metastin receptor as molecular biomarkers in clear cell RCC, upper tract urothelial carcinoma, and bladder cancer was evaluated by multivariate analysis. Low expression of metastin receptor in clear cell RCC and low expression of metastin in upper tract urothelial carcinoma were significant risk factors for metastasis, and low metastin expression was an independent prognostic factor in bladder cancer. CONCLUSION: Metastin and metastin receptor have potential as suitable molecular biomarkers for urological cancers. However, future studies of metastin and metastin receptor should undergo external validation to ensure consistency across different patient series, since individual institutional studies lack generalization.

Urological manifestations and treatment of the primary systemic vasculitides

The primary systemic vasculitides(PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa(PAN), Henoch-Sch?nleinPurpura(HSP), anti-neutrophil cytoplasm antibody associated Vasculitides(AAV), Giant Cell Arteritis(GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Beh?ets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological sideeffects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.

How to improve a urology outpatient service? A survey of patient satisfaction

AIM: To investigate and improve our out-patients department patient satisfaction, provide minimum consultation delay and appropriate consultation duration to meet with targets. METHODS: We distributed the modified satisfaction with outpatient service(SWOPS) questionnaires developed for use in Irish hospitals by the Health Services Research between August and December 2012. The patient disclosed their age and sex and completed the modified SWOPS questionnaire anonymously. Every patient was eligible to participate in the study who attended any of the Urology Outpatient Clinics. Patients lacking capacity to consent were excluded. Additionally, each patient was only permitted to complete one questionnaire regardless of repeat attendances within the 4 mo study period. The answers to every question were presented as percentages. One-way ANOVA was used to establish whether there was a significant difference in appointment delay and "Overall Satisfaction"on the different clinic days. The unpaired t-test was applied to establish whether "Overall Satisfaction" was affected by diagnosis(benign or malignant). Paired t-test was used to establish whether "Overall Satisfaction" was affected by appointment delay and appointment length. RESULTS: Three hundred and forty-eight questionnaires were completed with an overall > 65% participation rate. Eighty-one point six percent were male and 18.4% female with a mean age of 65 ± 21 years. Mean delay time was 32 min, which 30.6% stated should be an improvement priority. The delay times for Wednesday(mean 13 min) were significantly(P < 0.05) lower than for other days(mean 36 min). Generally 12-15 min outpatient appointment length is acceptable and adequate for patients as 97.70% suggested, however 31.60% of patients would favour longer duration. Eleven point four nine percent do not want to see different doctors each time, and 31.60% of the patient feel that no change is required. Average satisfaction was 84.65%. There was no significant relationship between satisfaction and clinic day, diagnosis and consultation length, whether the patient was reviewed by a registrar or consultant. Satisfaction was universally high and independent of consultation delay/length and diagnosis. Dissatisfaction in delay times with a significant improvement on Wednesday suggests necessary and achievable improvements. Notably, the Wednesday clinic has less patients per doctor per hour and enforces a 1 patient per 15 min slot with a no over-booking policy. CONCLUSION: Surveying our patient dissatisfaction would require more frequent audits by clinicians to improve patient satisfaction and to achieve better quality of care.

Prostate resection speed:A key factor for training and broad outcomes?

BACKGROUND Trans-urethral resection of prostate(TURP) is one of the most commonly performed operations in urology to treat bladder outflow obstruction(BOO) in men. TURP surgery is also a key for endo-urological training in the British National Health Service(NHS) for training junior urologists. The working hypothesis is that prostate resection speed(PRS) in the context of bipolar TURP surgery, is not a key factor in major complication rates or broad patient outcomes at 3 mo after surgery, and therefore supervising consultants should not focus primarily on resection speed when teaching TURP.AIM To investigate objective differences in consultants vs trainees PRS and whether PRS affected complication rates/outcomes after TURP.METHODS Retrospective descriptive study analyzing patient case-notes, operative and electronic records, study undertaken at Burton Queen's Hospital NHS Foundation Trust, United Kingdom, a secondary care centre in the public sector of the NHS. Participants included: all Bipolar TURPs undertaken between13/04/2016 and 27/06/2017. Exclusions: patients undergoing concomitant operations or where intra-operative equipment problems occurred. Resected prostate(g), operative time, post-operative complications and outcomes at 3-mo were obtained from electronic records. Clavien-Dindo Grade II complications or above considered significant. Binary successful yes/no outcome at 3-mo after surgery included both patients who reported moderate to significant symptom improvement, or being catheter-free for those catheterized before TURP.RESULTS157 patients were identified. After exclusion a total of 125 patients were included from analysis. The mean PRS for trainees(0.34 g/min) was found to be lower than the mean PRS for consultants(0.41 g/min). The operating urologist's PRS was not observed to be related to the number of TURPs that they performed during the period of the study. The trainee vs consultant means post-operative success rates(86.5% vs 90.5%) were comparable. The Trainees' patients did not suffer any significant complications as defined by the study. There was no clear relationship observed between PRS and the rate of significant post-operative complications or patients' 3-mo binary successful outcome. PRS was noted to increase with increasing intra-operative experience for both Trainees 1 and 2 when comparing the first half of their TURPs to their latter half.CONCLUSION Consultants have a higher PRS in comparison to trainees. There is no trend between PRS and significant post-operative complication rates or 3-mo outcomes.

Contemporary management of upper tract urothelial cell carcinoma

Upper tract urothelial cell carcinoma(UTUCC),formerly known as transitional cell carcinoma of the upper urinary tract,is a rare oncologic disease in Western countries.Thus its disease process and its management are not as well defined as other urologic cancers. We are reviewing the current evidence based literature available to develop a plan for the treatment of UTUCC. A Pub Med search was completed using the key words "upper tract urothelial cell carcinoma","epidemiology","risk factor","treatment" and "prognosis". Six hundred fifty two articles were found. We narrowed our search to articles published between January 2004 and June 2016 for a more contemporary review of the topic. Four hundred seventy articles were then available for review. Further detailed search was performed for relevance on the topic and hundred one articles were selected for the review. Many risk factors have been found to be associated with the development of UTUCC,including tobacco use. Patients are often asymptomatic and may only present with microscopic or gross hematuria. Tumor grade and stage are pivotal in determining the treatment options for UTUCC. Advancements in endoscopic techniques have aided in the diagnosis,grading and treatment of this disease. Treatment options include topical therapy,with combinations of methotrexate,vinblastine,doxorubicin and cisplatin or gemcitibine or cisplatin,endoscopic resection,segmental ureterectomy and ureteral implantation,and nephroureterectomy,including bladder cuff. Treatment recommendations depend on tumor grade and stage,renal function,tumor location and the patient's prognosis. There are currently no tissue or blood-based biomarkers available to accurately monitor the disease. Further studies of gene expression and biomarkers may hopefully improve the management of this disease. Although rare in many countries,UTUCC is becoming more prevalent due to exposure to carcinogenic herbal remedies and other identifiable risk factors. Numerous treatment modalities,both surgical and chemotherapeutic,have been utilized to treat both low and high grade UTUCC tumors. Additional clinical trials are necessary to further develop methods for screening,treatment,and surveillance to improve management.