Omit diagnostic ureteroscopy for upper tract urothelial carcinoma?

What is it about?

The study aimed to identify clinicopathological or radiological factors that can predict a diagnosis of upper urinary tract urothelial cell carcinoma (UTUC) to inform which patients can proceed directly to radical nephroureterectomy (RNU) without the delay for diagnostic ureteroscopy (URS). A total of 260 patients were identified, of whom 230 underwent URS. RNU was performed in 131 patients, of whom 25 proceeded directly without URS and all had a final histopathological diagnosis of UTUC. Major surgery was avoided in 77 patients where a benign or alternative diagnosis was made on URS, and 14 patients underwent nephron-sparing surgery. On multivariate logistic regression analysis, a presenting complaint of visible haematuria, a solid lesion reported on imaging, and a history of smoking were predictive of a final diagnosis of UTUC.

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Why is it important?

The research aims to identify clinicopathological or radiological factors that can predict a diagnosis of upper urinary tract urothelial cell carcinoma (UTUC) to inform which patients can proceed directly to radical nephroureterectomy (RNU) without the delay for diagnostic ureteroscopy (URS). The Key Takeaways: 1. from this text are: 2. A presenting complaint of visible haematuria, a solid lesion reported on imaging, and a history of smoking were found to be predictive of a final diagnosis of UTUC. 3. Major surgery was avoided in 77 patients (33.5%) where a benign or alternative diagnosis was made on URS, and 14 patients (6.1%) underwent nephron-sparing surgery. 4. Diagnostic URS was undertaken in 230 patients (88.5%), and over 96% of smokers who presented with visible haematuria and a solid lesion on computed tomography urogram had UTUC on final histopathology.