We report six patients with upper tract transitional cell neoplasms who were treated by an endourologic approach. Two patients had undergone nephroureterectomy previously, whereas one patient had a single functioning kidney. Two patients were deemed candidates for endourologic procedures secondary to significant comorbid disease precluding major open surgery. The final patient had a low-grade distal ureteral lesion and desired a conservative approach.Of six patients, two were rendered tumor free without recurrence 48 months and 60 months after surgery. Two patients had multiple superficial recurrences managed endoscopically and are currently disease free after 12 and 48 months, respectively. One patient died from metastatic transitional cell cancer 18 months postoperatively whereas one died perioperatively secondary to bleeding and multiple organ failure.Of five patients who tolerated endoscopic therapy, four were disease free with a mean follow-up of 30 months. Endoscopic treatment of upper urinary tract transitional cell carcinoma is feasible, although the risk of disease recurrence and progression may be significant.