PD43-12 WHAT PART DOES URETEROSCOPY PLAY IN THE DIAGNOSTIC PATHWAY OF UPPER TRACT TRANSITIONAL CARCINOMA? A TWO-YEAR REVIEW IN A HIGH-VOLUME INSTITUTION

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)1 Sep 2021PD43-12 WHAT PART DOES URETEROSCOPY PLAY IN THE DIAGNOSTIC PATHWAY OF UPPER TRACT TRANSITIONAL CARCINOMA? A TWO-YEAR REVIEW IN A HIGH-VOLUME INSTITUTION Radha Sehgal, Shifa Wong, Yasmin Abu-Ghanem, Theodore Birks, Rajesh Kucheria, Darrell Allen, Anuj Goyal, Paras Singh, Leye Ajayi, and Gidon Ellis Radha SehgalRadha Sehgal More articles by this author , Shifa WongShifa Wong More articles by this author , Yasmin Abu-GhanemYasmin Abu-Ghanem More articles by this author , Theodore BirksTheodore Birks More articles by this author , Rajesh KucheriaRajesh Kucheria More articles by this author , Darrell AllenDarrell Allen More articles by this author , Anuj GoyalAnuj Goyal More articles by this author , Paras SinghParas Singh More articles by this author , Leye AjayiLeye Ajayi More articles by this author , and Gidon EllisGidon Ellis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002057.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) is an established diagnostic tool in the diagnosis of upper tract urothelial carcinoma (UTUC); it enables exclusion of UTUC in cases of diagnostic uncertainty and facilitates endoscopic kidney-sparing management in selected cases. However, its use is controversial due to the potential risk of tumour seeding into the bladder and delays incurred in the diagnostic pathway. We aim to review the diagnostic value of URS a large cohort of patients investigated for UTUC. METHODS: We performed retrospective review of diagnostic URS at our institution for suspected UTUC between January 2018 to December 2019. Demographics, CT urogram (CTU) findings, cytology and intra-operative appearances were obtained from electronic records. Histology was recorded from ureteroscopic biopsy and where applicable, final radical nephroureterectomy (RNU). RESULTS: A total of 161 diagnostic URS were performed for suspected UTUC. Patients presented predominantly with haematuria (42%). Pre-operative CTU w demonstrated a filling defect/lesion (48%), hydronephrosis (25%), urothelial thickening (21%) or no abnormality (6%), where URS was performed due to persistent haematuria or blood from the ureteric orifice at cystoscopy. Selective cytology was positive in 34 cases (27%). Urothelium was visually suspicious in 71 cases (44%) and biopsy results were malignant in 41 cases (25%). A diagnosis of UTUC was confirmed based on cytology and histology in 47 cases (29%). Of these, 31 patients (66%) underwent RNU, 14 patients (30%) underwent kidney-sparing management and 2 patients (4%) were unfit for further surgery. Two patients underwent RNU where the final histology was not UTUC (renal cell carcinoma and renomedullary interstital tumour). Following a negative URS, 68 patients (54%) were discharged or reassured and 8 patients (6%) were referred to other specialties for non-urothelial tumours. CONCLUSIONS: Diagnostic URS is crucial in accurately diagnosing and staging UTUC. Of the 47 confirmed cases of UTUC, 30% of patients underwent kidney-sparing management. RNU was avoided in 61% of patients who were subsequently discharged following negative URS or diagnosed with non-urothelial tumours. We conclude that in cases of diagnostic uncertainty and where kidney-sparing management is feasible, URS should remain in the diagnostic pathway of UTUC. Further research into diagnostic pathway delays and intravesical recurrence in this cohort is ongoing. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e735-e735 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Radha Sehgal More articles by this author Shifa Wong More articles by this author Yasmin Abu-Ghanem More articles by this author Theodore Birks More articles by this author Rajesh Kucheria More articles by this author Darrell Allen More articles by this author Anuj Goyal More articles by this author Paras Singh More articles by this author Leye Ajayi More articles by this author Gidon Ellis More articles by this author Expand All Advertisement Loading ...