Fourteen selected patients with renal pelvic transitional cell carcinoma were managed percutaneously in our institution between March 1984 and April 1987. With a mean follow-up of 19 months, and excluding those patients who underwent immediate nephroureterectomy, six patients remain free of recurrent disease, which is similar to the results obtained with open parenchyma-sparing conservative operations. Our results suggest that percutaneous operations can provide cure in selected patients, including those with a normal contralateral kidney and with small (no more than 2-cm), single, low-grade, papillary tumors that are confined to the mucosa who, in addition, have negative cytology, negative random biopsies of contiguous mucosa, and no history of or concurrent transitional cell carcinoma elsewhere in the urinary tract. Further, our results suggest that second-look procedures with resection of suspicious residual disease, Nd:YAG laser irradiation of the tumor bed, and intracavitary administration of BCG all appear to help prevent recurrences.