The clinical role of the diagnostic ureteroscopy in upper urinary tract urothelial carcinoma (UTUC): Is it worth using it?
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v83i4.1002Keywords:
Upper tract urothelial carcinoma, diagnostic ureteroscopy, diagnosis, outcomesAbstract
Upper urinary tract urothelial carcinoma (UTUC) is a rare pathology representing 5-10% of urothelial carcinomas. The diagnosis is based on images (computed tomography urography or magnetic resonance urography) and urinary cytology, with good diagnostic accuracy. In doubtful cases, diagnostic ureteroscopy allows histopathologic confirmation, better staging, and identifying candidates for kidney-sparing surgery. The objective was to describe the role of diagnostic ureteroscopy and its clinical relevance on patients with suspicion of UTUC. We present a non-systematic review in Pubmed, including additional sources because of their relevance.
Regarding clinical studies, CT or RMN urography has a sensitivity and specificity of >90% with a limitation to identifying flat lesions. Urinary cytology has a detection rate ranging from 43-91% between sampling methods. Optical diagnosis, selective cytology, and biopsy are used when using diagnostic ureteroscopy. The most used tools are optic fiber flexible ureteroscope, flat-wire baskets, and cup biopsy forceps.
Ureteroscopy might decrease de Radical Nephroureterectomy (RNU) rate and misdiagnosis with histopathological confirmation. It also delays the time to RNU and increase of Intravesical recurrence (IVR) without compromising oncological outcomes (OS, CSS, MFS, RFS). The diagnostic ureteroscopy is a valuable tool in UTUC when clinical uncertainty.
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