With the evolution of ureteronephroscopes, a primary endoscopic approach to upper urinary tract filling defect has become possible with a strategy similar to that used for bladder tumors. Endoscopic resection can provide the histologic proof as well as the grade and the stage of the tumor without exposing the patient to additional cancer related risks. invasive tumors can be treated with an immediate nephroureterectomy. With a rigorous follow-up, superficial transitional cell carcinoma (TCC) of the upper tract with low and moderate grades can be treated endourologically,even in the presence of a normal contralateral kidney, with low morbidity and a long term efficiency comparable to that of nephroureterectomy.