Ureteral Tumors Research Articles

The Impact of Primary Tumor Location on Long-Term Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Systematic Review and Meta-Analysis.

Background: Upper tract urothelial carcinoma (UTUC) accounts for up to 10% of all urothelial neoplasms. Currently, various tumor-related factors are proposed to be of importance in UTUC prognostic models; however, the association of the primary UTUC location with oncological outcomes remains controversial. Thus, we sought to perform a systematic review and meta-analysis of the latest available evidence and assess the impact of primary tumor location on long-term oncological outcomes in patients with UTUC undergoing radical nephroureterectomy. Materials and Methods: A computerized systematic literature search was conducted in October 2021 through the PubMed, Web of Science, Scopus, and Cochrane Library databases. The primary endpoint was cancer-specific survival (CSS), and the secondary endpoints were overall survival (OS) and disease-free survival (DFS). Effect measures for the analyzed outcomes were reported hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among the total number of 16,836 UTUC in 17 included studies, 10,537 (62.6%) were renal pelvic tumors (RPTs), and 6299 (37.4%) were ureteral tumors (UTs). Pooled results indicated that patients with UT had significantly worse CSS (HR: 1.37, p < 0.001), OS (HR: 1.26, p = 0.003, and DFS (HR: 1.51, p < 0.001) compared to patients with RPT. Based on performed subgroup analyses, we identified different definitions of primary tumor location and geographical region as potential sources of heterogeneity. Conclusions: Ureteral location of UTUC is associated with significantly worse long-term oncological outcomes. Our results support the need for close follow-up and the consideration of perioperative chemotherapy in patients with UTUC located in the ureter. However, further prospective studies are needed to draw final conclusions.

Neoplasias del sistema urinario en perros y gatos

Primary neoplasms of the urinary system are uncommon in dogs and cats. When affecting the kidneys, carcinoma appear like most common in dogs and lymphoma in cats. Primary ureteral neoplasms are rare in dogs and there aren’t reports in cats. The primary bladder neoplasm described in dogs and cats is transition cell carcinoma; however, it is more frequent in dogs. Urethral neoplasms occur rarely and when diagnosed are usually amplifications of prostatic neoplasms or urinary bladder. The aim of assist in the diagnosis and medical conduct for both species, this report aims to present a literature review with the main neoplasms occurring in the urinary system that affect dogs and cats. Although these disorders are infrequent in the veterinary routine, an early diagnosis is necessary for a better prognosis for patients.

Analysis of Ureteral Tumour Stents for Malignant Ureteral Obstruction: Towards Reshaping an Optimal Stent.

IntroductionUreteral obstruction hinders the management of malignant diseases. Adequate stent placement does not necessarily guarantee renal decompression. The stent stiffness may play a major role to maintain patency. We carried out the present study in order to evaluate drainage efficiency by using stents with distinctive degrees of stiffness and to identify the physical factors that could prevent obstruction of the stent in patients with malignant ureteral obstruction (MUO).Materials and MethodsWe performed an analysis of 150 patients with MUO drainage at a single institution from June 2009 to June 2019. A progressive choice of stents was shaped to overcome each failure by focusing on the criterion of increasingly stiff stents.ResultsDuring the study period, 556 ureteral stent procedures (USP) were analysed separately. The stent failure with obstruction occurred in 23.0% (128/556) of USP at a mean of 4.4±3.6 months and depended on the type of stent. Stent failure occurred in 34.2% (70/205) of Vortek® stents, in 42.9% (15/35) of Urosoft stents, in 15.4% (39/254) of Superglide or ureteral catheters and in 6.5% (4/62) of tandem stents. No significant differences were found between Vortek® and Urosoft stents regarding stent failures, but there were significant differences between Superglide or Tandem stents and Vortek® or Urosoft stents (p<10−7). The study demonstrated that ureteral stent obstruction significantly decreased with a larger lumen or a stiffer stent (p<10−7).ConclusionIn the present study, Superglide and tandem stents were the best stents against stent failure, and the lumen and the stiffness of the stent have been shown to be critical factors in controlling patency. The results suggest that the lumen seems more important than the stiffness, and the stiffness would be the only means of keeping the lumen intact. Future stents for MUO should integrate the importance of the lumen of the stent.

Tumor distribution affects bladder recurrence but not survival outcome of multifocal upper tract urothelial carcinoma treated with radical nephroureterectomy

Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression.

Prognostic Analysis of Diagnostic Ureteroscopic Biopsy for Intravesical Recurrence of Upper Urinary Tract Urothelial Carcinoma

Objective: The aim of this study was to investigate whether diagnostic ureteroscopy (URS) biopsy is unfavourable for bladder tumour recurrence in upper urinary tract urothelial carcinoma (UTUC). Materials and Methods: We performed a retrospective analysis of 195 patients diagnosed with UTUC, who were divided into a diagnostic URS group (URS+) and a nondiagnostic URS group (URS–) according to whether diagnostic ureteroscopic biopsy was performed. A Cox regression model was used to analyse the risk factors for intravesical recurrence (IVR)-free survival (IRFS) and overall survival (OS) in UTUC after radical nephroureterectomy (RNU). Kaplan-Meier analysis was used to estimate the influence of factors on the incidence of IVR and the cumulative survival rate of UTUC. Results: Patients with a maximum tumour diameter of less than 3.1 cm, low-stage tumours, and ureteral tumours were more likely to undergo diagnostic URS before radical surgery. Multivariate Cox regression analysis showed that tumour pathological stage and diagnostic ureteroscopic biopsy can be used as predictors of IVR after RNU (p = 0.019, 0.033). Kaplan-Meier survival analysis found that diagnostic ureteroscopic biopsy was a high-risk factor for IRFS (p = 0.034). Subcomponent analysis showed that pTa/Tis/T1, pT2, pT3/pT4 stage, and diagnostic ureteroscopic biopsy with pTa/Tis/T1 stage were unfavourable for IVR (p = 0.047). Conclusion: Diagnostic ureteroscopic biopsy before RNU should be carefully selected for patients with atypical preoperative UTUC. We believe that intravesical chemotherapy drug perfusion can be used after surgery to prevent IVR if biopsy is unavoidable, but this still requires further prospective studies.

Contrast-enhanced ultrasonography promotes differential diagnosis of ureteral neoplasms.

To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with baseline ultrasound (B-US) in ureteral neoplasms. Retrospective analysis, comprising clinical presentation, image appearances, and diagnostic results on B-ultrasound and CEUS, considering pathological result as a gold-standard, was conducted on the clinical information of 39 patients with ureteral neoplasms. CT urography was used to detect and confirm the presence of ureteral neoplasms. Both B-ultrasound and CEUS investigations of those 39 patients under study were performed by a senior radiologist. Pathological outcomes established 27 ureteral malignancies and 12 ureteral benignancies. Ureteral malignancies were observed to occur in older patients than benignancies (p = 0.002). Only the morphological indicator of the ureteric wall on B-ultrasound was different in ureteral malignancies and benignancies (p = 0.030). Tumors with hyperenhancement, larger width, and hyperenhanced ureteric wall were easily diagnosed as malignant on CEUS, whereas iso-/hypoenhanced, narrower, and iso-/hypoenhanced ureteric wall indicated benign tumors. Moreover, the lesion widths, enhanced morphologies of the ureteric wall, and the ureteral wall's linear boundaries on CEUS were different between high- and low-stage ureteral urothelial carcinomas (p = 0.012, 0.002, 0.001, respectively). The display of microvessels in ureteral neoplasms was significantly enhanced by CEUS, thus contributing to the differential diagnosis of ureteral neoplasms while assisting the staging of ureteral urothelial carcinoma. The imaging features of different ureteral neoplasms on CEUS were analyzed in this study. The diagnostic performances of CEUS and B-ultrasound in ureteral urothelial carcinomas were also explored.

V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Nikhil Gopal, Sameh Naim, Bertie Zhang, John Phillips, and Majid Eshghi Nikhil GopalNikhil Gopal More articles by this author , Sameh NaimSameh Naim More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with ureteral tumors managed endoscopically often benefit from adjuvant immuno-chemotherapy and require interval upper tract surveillance with ureteroscopy. However, both often require general anesthesia, which can be problematic for a predominantly elderly population with multiple co-morbidities. Here we describe an endoscopic technique of ureteral meatotomy to not only predictably allow for reflux of intravesical agents through the ureter, but also to allow upper tract endoscopy to be performed in the office setting. METHODS: From 2015-2021, we performed ureteral meatotomy on 10 patients. All patients who underwent this procedure had upper tract urothelial tumors deemed suitable for primary endoscopic management, based on patient’s clinical characteristics; tumor number; size; location; and/or biopsy grade.Under general anesthesia, a 10 F dual lumen ureteral catheter or 6-12 F Nottingham dilator was inserted into the distal ureter in order to allow for alignment of the ureter towards the bladder neck and to ensure the orifice is incised in the correct direction. Using either a Holmium laser or Collin’s knife, a full-thickness 2 cm incision was made on the distal intramural ureter at the 12 o’clock position, until the anterior portion of the catheter was visualized. Intraoperative cystogram was used to confirm ureteral reflux. A double J stent was then left in place for 3 weeks for mucosal healing and reshaping of the distal ureteral segment. Postoperatively, patients underwent 6 cycles of mitomycin, either via indwelling Foley catheter or nephrostomy tube. Lower and upper urinary tract surveillance was performed using flexible cystoscope and/or ureteroscope in the office every 3-6 months for the first two years and annually thereafter. RESULTS: 10 patients with average age of 77 years, 40% of whom were male, underwent ureteral meatotomy between 2015 and 2021. 90% of tumors were either in the distal ureter or UPJ/renal pelvis. Average tumor size was 1.6 cm. 70% of tumors were low grade on biopsy. 3 patients had concomitant bladder cancer. There were no complications associated with chemotherapy instillation. Of the patients who had only upper tract disease, none developed a new recurrence in the bladder. CONCLUSIONS: We describe a novel anterior intramural ureteral incision technique in patients with ureteral tumors managed endoscopically that reliably allows for both chemotherapy administration and upper tract surveillance in an office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1078-e1078 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gopal More articles by this author Sameh Naim More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Majid Eshghi More articles by this author Expand All Advertisement Loading ...

Primary leiomyoma of the ureter: a case report

BackgroundOnly 14 cases of leiomyoma with ureteral origin have been reported previously. Such primary leiomyomas often present as hydronephrosis, making the diagnosis difficult. Radical nephroureterectomy is often performed because of the possible diagnosis of a malignant tumor. We report the 15th case of primary leiomyoma with a ureteral origin.Case presentationA 51-year-old Japanese man presented with a chief complaint of asymptomatic gross hematuria with a history of hypertension. Enhanced computed tomography showed a tumor at the upper part of the right ureter that appeared to be the cause of hydronephrosis and contracted kidney; no retroperitoneal lymphadenopathy and distal metastasis were observed. A well-defined 20-mm (diameter) defect was identified at the upper of the right ureter on retrograde pyelogram with no bladder cancer on cystoscopy. Urine cytology and right divided renal urine cytology findings were negative. Laparoscopic nephroureterectomy was performed, and the extracted tumor measured 20 × 13 mm. Histopathological examination revealed primary leiomyoma with no recurrence 16 months after the operation.ConclusionsPreoperative examination with the latest available ureteroscopic technology can help preserve renal function in the case of benign tumors by enabling preoperative ureteroscopic biopsy or intraoperative rapid resection. Moreover, nephroureterectomy is recommended in the case of preoperative suspicion of ureteral malignant tumors.

Transurethral resection of bladder cancer involving the orifice of the ureter

In 90-95 % of cases, urothelial cancer primarily affects the bladder and in about 5-49 % of patients it can be located near or completely close the orifice of the ureter. Metachronous urothelial cancer of the upper urinary tract occurs, as a rule, 3 or more years after transurethral resection of the primary bladder tumor or radical cystectomy, and its frequency with involvement of the ureteral orifice ranges from 0 to 20 %, reaching 51 %. Currently, there are no clear recommendations and diagnostic and treatment algorithm for the management of this category of patients. This review examines the frequency, possible causes and risk factors for recurrence of upper urinary tract tumors, indications for organ-preserving treatment, features of surgical technique for transurethral resection of ureteral orifice tumors, emerging complications and methods of their prevention.

Renal pelvic rupture: A case report of an unexpected cause.

IntroductionRenal pelvic rupture (RPR) is a rare condition, that is most usually caused by obstructive calculi.In another hand, primal ureteral tumors are also uncommon, with only a few cases reporting their involvement in a RPR.Presentation of caseWe report a case with a multimodality discussion of an ureteral tumor, with a spontaneous renal pelvic rupture (RPR) forming a large retrorenal urohematoma.DiscussionOnly few series reported the subject of RPR in the English literature. Only some single cases reported the causality of urinary tract tumors in RPR.RPR is an imaging based diagnosis. Herein, upper urinary tract tumors show a variable appearances at imaging.ConclusionBy reporting this case, we highlight the role of both computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis of the RPR and their accuracy in the detection of the ureteral tumor. We also consolidate the effectiveness of the conservative attitude in the management of the RPR.

The Management of Distal Ureter During Radical Nephroureterectomy Does Not Influence Bladder Recurrence.

Purpose: The bladder cuff (BC) management and its surgical approach represent an essential and debated step in radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. The objective of our study was to determine which BC management has the best oncologic outcomes in terms of bladder recurrence-free survival (BRFS). Methods: We retrospectively analyzed all patients who underwent an open robot-assisted laparoscopic (RNU) or a combined RNU between March 2012 and March 2019 in three academic hospitals. BC management approaches were divided into two categories: (O-cuff) open BC and (R-cuff) robot-assisted BC. We assessed demographic characteristics, distal ureter approach, pathology, and operative details, as well as oncologic outcomes including BRFS. Survival was analyzed using the Kaplan-Meier method and compared using the log-rank test. A multivariable analysis was performed to identify predictive factors of bladder recurrence (BR). Results: A total of 117 patients were included with a mean follow-up of 40.4 months. Patients with a history of bladder cancer, RNU with pure laparoscopic approach, and endoscopic BC were excluded. There were 53 (45%) patients in the O-cuff group and 64 (55%) in the R-cuff group. BRFS at 2 years was 73.3% and 72.7% for O-cuff and R-cuff, respectively (p = 0.9). On multivariable analysis, distal ureter tumor (odds ratio: 6.24, 95% confidence interval: 1.95-21.5; p < 0.01) was associated with BR. Conclusion: There was no statistically significant difference in BRFS between the O-cuff and R-cuff groups. Nevertheless, we underlined that distal ureter tumor was associated with BR. Although we did not find differences regarding the surgical approach, BC remains a very important step of RNU and caution should be taken when performed laparoscopically to avoid any tumor spillage. Risk factors for bladder cancer recurrence might be taken into account for the choice of its surgical approach.

P0803 - Propensity score based comparison of nephroureterectomy versus segmental ureterectomy for ureteral tumors

P0803 - Propensity score based comparison of nephroureterectomy versus segmental ureterectomy for ureteral tumors

Survival differences of patients with ureteral versus pelvicalyceal tumours: a systematic review and meta-analysis.

IntroductionWorse survival in upper tract urothelial carcinoma (UTUC) in the presence of a tumour in the ureter vs. pelvicalyceal tumours is reported in some studies; however, the definition of ureteral involvement (UI) varies across studies. We systematically evaluated evidence regarding the prognostic role of UI in overall and cancer-specific survival of patients with UTUC.Material and methodsA systematic search of PubMed, Scopus and Web of Knowledge was performed in March 2018.ResultsThe results were presented as a comparison between ureteral vs. pelvicalyceal tumours. A total of 14,895 patients were identified. Cumulative analyses indicated that UI worsens cancer-specific survival (CSS) and overall survival (OS), with a pooled HR of 1.52 (p < 0.001) and 1.39 (p = 0.004), respectively.ConclusionsOur meta-analysis identified UI in UTUC as an adverse prognostic factor.

Safety of adjuvant gemcitabine plus cisplatin chemotherapy in a patient with bilateral ureteral cancer undergoing hemodialysis

An 80 year old Japanese man with bilateral ureteral cancer underwent laparoscopic bilateral nephroureterectomy and lymph-node dissection. The pathological stage of the left and right ureteral tumors was pT3pN0M0. He received two courses of adjuvant gemcitabine and cisplatin chemotherapy while undergoing hemodialysis. The standard dose of gemcitabine and 50% of the standard dose of cisplatin were administered on the same day. Hemodialysis was started 6 h after gemcitabine administration and 1 h after cisplatin administration. The side effects were evaluated according to the Common Terminology Criteria for Adverse Events v4.0. In the first course, Grade 4 side effects including leukopenia, neutropenia, and thrombocytopenia were observed. He was treated with granulocyte colony-stimulating factor and platelet transfusion. Because the second course was administered without reducing the doses, granulocyte colony-stimulating factor was administered prophylactically, and Grade 4 side effects were reduced to Grade 3. Gemcitabine plus cisplatin chemotherapy can be administered safely in a patient with advanced ureteral cancer undergoing hemodialysis by adequately managing adverse events.

Endoscopic laser resection of a ureteral tumour in primary multiple malignant neoplasms

A case of the ureteral tumour endoscopic treatment is presented in a patient with primary multiple malignancies. In the case of polyneoplasia, there are usually two or more neoplasms of different localizations, including the organs of the urinary system. The kidney and prostate tumours are diagnosed more often, but in rare cases, ureter neoplasms. It is especially important to perform organ-sparing surgeries when diagnosing ureter neoplasms. In addition, chronic kidney disease after radical nephroureterectomy can be a relative contraindication to further chemoradiation therapy in polyneoplasias. In this patient, along with the breast and vulva neoplasms, a solitary tumour of the right ureter's lower third was detected, which was successfully removed endoscopically. The chosen method of minimally invasive treatment allowed to preserve a normal functioning kidney, to avoid the development of chronic kidney disease in the patient, who was later scheduled for chemotherapy.

Ureteral polyps protruding from the urethra

BackgroundUreteral fibro-epithelial polyp (UFP) is a rare benign ureteral tumor, and surgical removal of the polyps is still the preferred solution. Although many cases have reported polyps extending to the bladder, our case was the first to report a huge UFP that underwent endoscopic laser resection to highlight the urethra and cause severe end hematuria permanently.Case presentationIn 2019, a 37-year-old woman came to the hospital because of hematuria and a dark red extraurethral mass. CTU inspection showed: filling defect between the right ureter and the bladder at the entrance of the bladder. After ureteroscopy, it was found that the ureteral mass came out of the urethral orifice. Then, under the direct view of the ureteroscope, a Ho:YAG laser was used to remove the tumor by cutting off along the its base, and the patient was discharged 3 days after the operation.ConclusionUrethral polyps from the ureter should be considered in the differential diagnosis of urethral neoplasms. Ho:YAG laser resection under ureteroscopy is an effective option for treating UFP, but be careful of ureteral stricture after surgery.

Comparative analysis of patients with upper urinary tract urothelial carcinoma in black-foot disease endemic and non-endemic area

BackgroundA high incidence of upper urinary tract urothelial carcinoma has been reported in the southwestern area of Taiwan, where arsenic water contamination was considered the main cause. However, there is no definite proof to show a correlation between arsenic water contamination and upper urinary tract urothelial carcinoma. To investigate the clinical and epidemiological features of patients with upper urinary tract urothelial carcinoma between arsenic water endemic and non-endemic areas, we analyzed patients in terms of characteristics, stratified overall survival, disease-free survival, and cancer-specific survival.MethodsThe records of a total of 1194 patients diagnosed with upper urinary tract urothelial carcinoma were retrospectively reviewed. Clinical data and current medical status were collected from the medical records. Statistical analyses were performed to determine the clinical variables and stratified survival curves between endemic and non-endemic groups.ResultsFemale predominance was revealed in both endemic and non-endemic groups (male:female ratio = 1:1.2–1.4). No statistical differences were found in histological types, staging, and tumor size between the two groups. Nonetheless, patients with characteristics of aging and having end-stage renal disease were outnumbered in the non-endemic group, while a higher prevalence of previous bladder tumors and more ureteral tumors were found in the endemic group. Adjusted stratified cumulative survival curves suggested a poorer prognosis in endemic patients, especially in disease-free survival of early stage disease.ConclusionsA higher mortality rate with more previous bladder cancer history and ureteral tumors was seen in patients with upper urinary tract urothelial carcinoma residing in the arsenic water contamination area. This may be attributed to the long-term carcinogenic effect of arsenic underground water.

A renal unit saving approach to IgG4 related periureteral mass mimicking malignant ureteral tumor

Immunoglobulin G4-related disease (IgG4-RD) is a rare disease with few cases mimicking ureteral tumour identified after the ablative surgery. We report a case of IgG4-RD that presented as a ureteral mass which was diagnosed prior to surgery and managed conservatively. A 63-year-old man presented with prior diagnosis of the right ureteric tumour but a radiological review suspected it could be something else. The patient underwent laparoscopic biopsy from the periureteric mass. Biopsy reported to be IgG-4 disease and managed conservatively. This case highlights the rare possibility of IgG4-disease mimicking ureter tumour and if diagnosed prior to extirpative surgery can result in salvage of the kidney.

The accuracy of computed tomography in the diagnosis of upper urinary tract urothelial carcinoma in correlation with the final histopathology: A retrospective study in 275 patients at a Tertiary Urology Institute.

Introduction:Because the reports in the literature of radiologic investigations for upper tract urothelial cancer (UTUC) are limited by the number of patients, and included patients with different pathologies, we aimed to study the overall accuracy of computed tomography (CT) in the diagnosis of UTUC and their accuracy on predicting tumor location.Methods:A retrospective review from 1990 to 2017 included patients who were treated for UTUC. Unenhanced CT scan was obtained first using Multi-Detector Computed Tomography (MDCT, Philips Medical Systems), then nonionic contrast medium, containing 350 mg iodine/ml was injected at 4 mL/s. Analysis was performed using SPSS®.Results:Of 275 patients, complete data on CT was available on 270 (98%) patients. CT reported only two false positive and six false negative results and the overall accuracy was 96-97%. In comparison to the final pathological reports, CT/CTU detected 85% of the tumor location of in the renal pelvic and 50% of the calyceal tumors. In ureteric tumors, they detected distal (66/71= 93%) more than proximal ureteric tumors (60%).Conclusion:In our cohort, CT/ CTU has a high overall accuracy (97%) in diagnosing UTUC, capability to well visualize tumors of distal ureter and renal pelvis, but could miss calyceal tumors. The matter to rely only on CT without ureteroscopic biopsy in the diagnosis of UTUC especially if radical surgery is planned needs further prospective studies.

Ureteroscopy for the diagnosis of upper tract urothelial cancer: The outcome in a series with 275 patients in correlation with the final histopathology

Background: There is still an unresolved debate about whether ureteroscopy (URS) and biopsy are required as a routine for the diagnosis of upper tract urothelial cancer (UTUC) or if these procedures can be omitted in appropriately selected patients. We aimed to report the overall diagnostic accuracy of URS biopsy for ureteral tumors in concordance with the final histopathology. Materials and Methods: We conducted this retrospective study from 2000 to 2019. Data on URS biopsies for ureteral tumors which included pathological diagnosis, staging, and grading were collected. These data were then compared to the results of contrast-enhanced computed tomography (CT) and the final histopathological reports. Results: The data of 275 patients with a mean age of 59 ± 11 years were collected. Complete data regarding URS biopsies for ureteral tumors were available in 94 cases with an overall diagnostic accuracy in detecting malignancy of 93%. When matched to the final histopathology, the accuracy of URS biopsies increased as the tumor grade increased. Upgrading was noticed in 36% of the biopsies. Biopsy grade was an accurate predictor of stage. CT was performed in 270 cases with an overall accuracy of 96%. URS did not affect post-UTUC intravesical recurrence (P = 0.9) or overall survival (log rank = 0.08). Conclusion: URS biopsy for ureteral tumors was highly specific with fair predictive ability for tumor grade, and it could predict tumor stage. URS may not increase intravesical recurrence or affect overall survival. However, false-negative results were noted, which did not change the surgical plan when radical surgeries were decided based on CT.