Traditionally, a nephron-sparing endoscopic approach to UT-TCC was reserved for imperative indications. Recently though, this has been challenged with endoscopy applied more frequently in elective cases. However, as UT-TCC remains relatively uncommon, the literature for endoscopic therapy is accordingly limited. A Cochrane review of the surgical management of UT-TCC in 2011 concluded that there is no high quality evidence available to determine the best surgical management, although current data, albeit limited, suggests a similar oncologic outcome when endoscopy is compared to an open approach [
6]. Our study adds to the relatively small number of comparative studies focusing on patients with low grade UT-TCC, and furthers the growing understanding that nephroureterectomy may in fact be overtreatment. In a similar finding to Grasso et al. [
7], our results indicate that patients' safety and disease-related mortality are not hindered by a nephron-sparing approach. Whereas there is little risk of disease progression and associated mortality for low-grade UT-TCC, the risk of ureteral and bladder recurrence is significant, and is absolutely dependent on a stringent follow-up protocol. In two separate reports of endoscopic treatment of low-grade UT-TCC with medium to long-term follow-up, upper tract recurrence ranged between 74% and 84%, with cancer-specific survival of 100% [
8,
9]. In a report of medium-term follow-up of low and high-grade UT-TCC resected endoscopically, Thompson et al. revealed ureter and bladder recurrence in 55% and 45% respectively, with high-grade and non-Ta staging associated with greater mortality [
10]. Similarly, in their review, Cutress et al. identified a pooled recurrence rate of 52% following endoscopic therapy for UT-TCC, with a grade-dependent trend. Further, size (>2 cm), prior history of bladder tumor, and greater than three previous bladder tumor resections were associated with UT recurrence [
11]. Our results suggest similar bladder and ureter recurrence rates with excellent disease-related mortality, possibly due to our careful patient selection (tumor size up to 1.5 cm and papillary low-grade appearance at primary resection). As with all other related studies, this study is limited by its retrospective nature as well as relatively long treatment period (ten years), both a result of the rarity of the disease. Nevertheless, it would seem almost impossible to prospectively recruit patients for a randomized study.