Does ureteroscopy still have a role in the diagnosis of upper tract urothelial carcinoma? A two-year review in a high-volume centre.
BAUS ePoster online library. Sehgal R. 06/23/21; 319050; p14-2
Disclosure(s): N/A
Radha Sehgal
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Introduction
Ureteroscopy (URS) is an established tool in the assessment of upper tract urothelial carcinoma (UTUC); it enables exclusion of UTUC and facilitates kidney-sparing surgery (KSS) in selected cases. However, its use is controversial due to potential risk of intravesical tumour seeding and diagnostic pathway delays. We review the diagnostic value of URS in a large cohort of patients investigated for UTUC.
Materials and Methods
We performed a retrospective review of diagnostic URS for suspected UTUC between January 2018 to December 2019.
Results
A total of 161 diagnostic URS were performed for suspected UTUC. Pre-operative CT urogram demonstrated a filling defect/lesion (48%), hydronephrosis (25%), urothelial thickening (21%) or no abnormality (6%). A diagnosis of UTUC was confirmed in 47 cases (29%). Of these, 31 patients (66%) underwent radical nephroureterectomy (RNU), 14 patients (30%) underwent KSS and 2 patients (4%) were unfit for further surgery. Following negative URS, 68 patients (54%) were discharged and 8 patients (6%) were referred to other specialties for non-urothelial tumours.
Conclusions
RNU was avoided in 61% of patients with a negative URS or non-urothelial diagnosis. KSS was performed in 30% of patients with UTUC. We conclude that in cases of diagnostic uncertainty and where KSS is feasible, URS should remain in the diagnostic pathway of UTUC. Although evidence suggests association with increased intravesical recurrence, this has not been shown to impact overall survival.
Ureteroscopy (URS) is an established tool in the assessment of upper tract urothelial carcinoma (UTUC); it enables exclusion of UTUC and facilitates kidney-sparing surgery (KSS) in selected cases. However, its use is controversial due to potential risk of intravesical tumour seeding and diagnostic pathway delays. We review the diagnostic value of URS in a large cohort of patients investigated for UTUC.
Materials and Methods
We performed a retrospective review of diagnostic URS for suspected UTUC between January 2018 to December 2019.
Results
A total of 161 diagnostic URS were performed for suspected UTUC. Pre-operative CT urogram demonstrated a filling defect/lesion (48%), hydronephrosis (25%), urothelial thickening (21%) or no abnormality (6%). A diagnosis of UTUC was confirmed in 47 cases (29%). Of these, 31 patients (66%) underwent radical nephroureterectomy (RNU), 14 patients (30%) underwent KSS and 2 patients (4%) were unfit for further surgery. Following negative URS, 68 patients (54%) were discharged and 8 patients (6%) were referred to other specialties for non-urothelial tumours.
Conclusions
RNU was avoided in 61% of patients with a negative URS or non-urothelial diagnosis. KSS was performed in 30% of patients with UTUC. We conclude that in cases of diagnostic uncertainty and where KSS is feasible, URS should remain in the diagnostic pathway of UTUC. Although evidence suggests association with increased intravesical recurrence, this has not been shown to impact overall survival.
Introduction
Ureteroscopy (URS) is an established tool in the assessment of upper tract urothelial carcinoma (UTUC); it enables exclusion of UTUC and facilitates kidney-sparing surgery (KSS) in selected cases. However, its use is controversial due to potential risk of intravesical tumour seeding and diagnostic pathway delays. We review the diagnostic value of URS in a large cohort of patients investigated for UTUC.
Materials and Methods
We performed a retrospective review of diagnostic URS for suspected UTUC between January 2018 to December 2019.
Results
A total of 161 diagnostic URS were performed for suspected UTUC. Pre-operative CT urogram demonstrated a filling defect/lesion (48%), hydronephrosis (25%), urothelial thickening (21%) or no abnormality (6%). A diagnosis of UTUC was confirmed in 47 cases (29%). Of these, 31 patients (66%) underwent radical nephroureterectomy (RNU), 14 patients (30%) underwent KSS and 2 patients (4%) were unfit for further surgery. Following negative URS, 68 patients (54%) were discharged and 8 patients (6%) were referred to other specialties for non-urothelial tumours.
Conclusions
RNU was avoided in 61% of patients with a negative URS or non-urothelial diagnosis. KSS was performed in 30% of patients with UTUC. We conclude that in cases of diagnostic uncertainty and where KSS is feasible, URS should remain in the diagnostic pathway of UTUC. Although evidence suggests association with increased intravesical recurrence, this has not been shown to impact overall survival.
Ureteroscopy (URS) is an established tool in the assessment of upper tract urothelial carcinoma (UTUC); it enables exclusion of UTUC and facilitates kidney-sparing surgery (KSS) in selected cases. However, its use is controversial due to potential risk of intravesical tumour seeding and diagnostic pathway delays. We review the diagnostic value of URS in a large cohort of patients investigated for UTUC.
Materials and Methods
We performed a retrospective review of diagnostic URS for suspected UTUC between January 2018 to December 2019.
Results
A total of 161 diagnostic URS were performed for suspected UTUC. Pre-operative CT urogram demonstrated a filling defect/lesion (48%), hydronephrosis (25%), urothelial thickening (21%) or no abnormality (6%). A diagnosis of UTUC was confirmed in 47 cases (29%). Of these, 31 patients (66%) underwent radical nephroureterectomy (RNU), 14 patients (30%) underwent KSS and 2 patients (4%) were unfit for further surgery. Following negative URS, 68 patients (54%) were discharged and 8 patients (6%) were referred to other specialties for non-urothelial tumours.
Conclusions
RNU was avoided in 61% of patients with a negative URS or non-urothelial diagnosis. KSS was performed in 30% of patients with UTUC. We conclude that in cases of diagnostic uncertainty and where KSS is feasible, URS should remain in the diagnostic pathway of UTUC. Although evidence suggests association with increased intravesical recurrence, this has not been shown to impact overall survival.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}