The early clinical manifestations of epithelial cell carcinoma of upper urinary tract are not obvious, and often are recurrent episodes of painless carnal hematuria. Low back pain is mostly caused by blood clots passing through ureter or tumor invading retroperitoneal tissues. Urethral irritation signs appear mostly with bladder tumor. Upper urinary tract uroepithelial cell carcinoma includes renal collecting system carcinoma and ureteral carcinoma, which accounts for 5% of the whole uroepithelial tumor. Renal pelvic cancer is relatively common, with an incidence 3-4 times that of ureteral cancer. Ureteral cancer often occurs in 75% of the lower segment, 20% of the middle segment, and 5% of the upper segment. The incidence of epithelial cell carcinoma of the upper urinary tract gradually increases after the age of 60, with a peak age of 70-80 years, and slightly more women than men are affected in China. The clear risk factors for the disease are mainly tobacco (smoking, including second-hand smoke) and occupational exposure: acetonaphthamine and benzidine in chemical industry (latency period 7-20 years); other causes are unknown. The relationship between upper urinary tract epithelial cell carcinoma and bladder cancer: urothelial cell carcinoma is polycentric (multifocal and multisite characteristics) 1. 17% of combined bladder cancer; 2. 22-47% of all upper urinary tract epithelial cell carcinomas have bladder cancer, and 2-6% of contralateral upper urinary tract have cell carcinoma; 3. 60% of upper urinary tract epithelial cell carcinomas are invasive at diagnosis; while 15-25% of bladder cancer are invasive at diagnosis of bladder cancer are invasive. Therefore, it is important not to ignore the combination of bladder cancer/new onset of bladder cancer at diagnosis and follow-up. Preoperative diagnosis and treatment methods of upper urinary tract epithelial cell carcinoma Imaging: 1.B ultrasound: non-invasive, non-radiation, inexpensive, and is a common screening tool to detect indirect signs such as dilated hydronephrosis of the renal pelvis and ureter caused by tumor, and to identify kidney and bladder lesions and negative stones. Disadvantages: easy to receive gas interference, poor ureteral visualization. 2, CT: helps to diagnose and stage; CTU: shows the site and scope of the mass, manifesting as intrapelvic occupancy, ureteral irregular thickening, luminal narrowing and effusion over obstruction, extra-ureteral infiltration, distant metastasis, etc. 3, MRI: no radiation, no renal function damage, can show the size of the ureteral lumen, lesion site, and scope; performance: sudden truncation of the ureter, obstruction site found in the lumen or protruding extra-luminal soft tissue masses. Disadvantages: MRU: not significant when the upper urinary tract is not significantly dilated. 4.Intravenous pyelogram (IVU): It shows filling defect and hydronephrosis in early stage of incomplete obstruction, and can show the morphology and function of both kidneys and tumor pattern. Disadvantage: When the obstruction is severe, the affected side is not visualized, so the value is limited. 5.Retrograde pyeloureterogram: It can show tumor shape, size and location; ureteral cancer manifestation: “shuttle”, “urinary spout” like irregular filling defect or classic “goblet” sign. signs. PET/CT: sensitivity and specificity are 92.9% and 100% respectively, better than IVU and CT; however, fewer cases and higher cost. Cytological examination 1.Urine exfoliative cytological examination: it has important value for the clinical qualitative diagnosis of upper urinary tract epithelial cell carcinoma, with the advantages of easy operation, non-invasive and high specificity, but low sensitivity. Recently, liquid-based thin-layer cytology technique (TCT) can improve the accuracy. Ureteral cannula for urine collection and ureteral brush can improve the sensitivity of the test. Notes on urine collection: 200-300 ml of fresh morning urine should be collected and sent for testing within 2-3 hours. Try to avoid overnight morning urine, because the urine in the bladder for too long will lead to swelling and denaturation of exfoliated tumor cells, affecting the accuracy of result interpretation. 2.Urinary fluorescence in situ hybridization (urinary FISH): high sensitivity, low specificity, disadvantages: cannot be diagnosed qualitatively, high false positive, high cost, not yet popularized in primary hospitals. Ureteroscopy: It is the gold standard for the diagnosis of upper urinary tract epithelial cell carcinoma. Cystoscopy and ureteroscopy can detect combined bladder cancer lesions, directly observe the situation in the ureteral lumen, and detect early and undetectable tumors by imaging. It is limited by certain technology and equipment, high cost, invasive examination, and not easy to be used as a routine examination method. Treatment: Surgery is the best method to treat upper ureteral epithelial cell carcinoma. The scope of surgery should be determined according to the patient’s physical condition, contralateral kidney function, tumor site and growth mode, stage and grading. For highly staged and high-grade tumor, kidney and ureterectomy + bladder sleeve resection (hemiurethral) should be performed on the affected side. For contralateral renal insufficiency, isolated kidney or bilateral tumor, kidney preservation surgery is chosen, but close follow-up should be performed after surgery. Because hemiurethral surgery requires removal of organs, large surgical area, great damage and long postoperative recovery time for patients, clinicians are often very careful before choosing this surgical method, and a clear qualitative diagnosis before surgery is especially important. The treatment of epithelial cell carcinoma of upper urinary tract is mainly surgery, supplemented by chemotherapy and radiation therapy, and postoperative bladder irrigation regularly. The surgical methods include open surgery and laparoscopic minimally invasive technique. Laparoscopic radical resection of kidney, ureter and bladder sleeve has the same surgical effect as open surgery. It has the advantages of less trauma, faster recovery and fewer complications, but the laparoscopic equipment and techniques are highly demanding. I have completed many cases of laparoscopic radical nephrectomy, partial nephrectomy, radical resection of upper urinary tract cell carcinoma and other laparoscopic surgeries, and I am skilled in surgery.