Is Ureteroscopy Needed Prior to Nephroureterectomy? An Evidence-Based Algorithmic Approach.

Abstract:

OBJECTIVE:To develop an evidence-based approach to the diagnostic workup of suspicious upper urinary tract lesions. METHODS:The PubMed database was searched using the following terms with a filter for English language: "upper tract urothelial carcinoma" and "upper tract transitional cell carcinoma," along with the following corresponding terms: "cost," "epidemiology," "diagnosis," "ureteroscopy," and "workup." A total of 404 articles were returned, and 33 were reviewed in full based on relevance. RESULTS:Computed tomography urogram is both sensitive and specific (96% and 99%). Cytology is utilized for its specificity (89%-100%). Ureteroscopy and biopsy of an upper tract lesion can be helpful in equivocal cases but can pose challenges in terms of yield and eventual pathologic upstaging. Due to the high sensitivity and specificity of other noninvasive tests, ureteroscopy can be obviated in select cases. We assess the available evidence and devise an algorithm for the evaluation of an upper tract urothelial carcinoma lesion. CONCLUSION:Ureteroscopy can be omitted as part of the diagnostic workup in appropriately selected cases of upper tract urothelial carcinoma.

journal_name

Urology

journal_title

Urology

authors

Potretzke AM,Knight BA,Potretzke TA,Larson JA,Bhayani SB

doi

10.1016/j.urology.2015.08.046

subject

Has Abstract

pub_date

2016-02-01 00:00:00

pages

43-8

eissn

0090-4295

issn

1527-9995

pii

S0090-4295(15)01013-4

journal_volume

88

pub_type

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