New Clinical Practice Guidelines, September 2017

John Anello; Brian Feinberg; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO; Yonah Korngold; John Heinegg. Sam Shlomo Spaeth

Disclosures

September 15, 2017

In This Article

Urothelial Carcinoma

Guidelines on upper urinary tract urothelial carcinoma by the European Association of Urology[16]

  • Perform urinary cytology as part of a standard diagnostic workup.

  • Perform a cystoscopy to rule out concomitant bladder tumor.

  • Perform a computed tomography urography for upper tract evaluation and for staging.

  • Use diagnostic ureteroscopy and biopsy in cases where additional information will impact treatment decisions.

  • Use microsatellite instability as an independent molecular prognostic marker to help detect germline mutations and hereditary cancers.

  • Use the American Society of Anesthesiologists score to assess cancer-specific survival following surgery.

  • Offer kidney-sparing management as primary treatment option to patients with low-risk tumors and 2 functional kidneys.

  • Offer kidney-sparing management in patients with solitary kidney and/or impaired renal function, provided that it will not compromise the oncologic outcome. This decision will have to be made on a case-by-case basis, engaging the patient in a shared decision-making process.

  • Offer a kidney-sparing approach in high-risk cancers for distal ureteral tumors and in imperative cases (solitary kidney and/or impaired renal function).

  • Use a laser for endoscopic treatment of upper tract urothelial carcinoma.

  • Perform radical nephroureterectomy in the following situations: suspicion of infiltrating upper tract urothelial carcinoma on imaging; high-grade tumor (urinary cytology); multifocality (with 2 functional kidneys); noninvasive but large (>2 cm) upper tract urothelial carcinoma.

After radical nephroureterectomy >5 yr

Noninvasive tumor

  • Perform cystoscopy/urinary cytology at 3 mo, and then annually.

  • Perform computed tomography urography every year.

Invasive tumor

  • Perform cystoscopy/urinary cytology at 3 mo, and then annually.

  • Perform computed tomography urography every 6 mo for 2 yr, and then annually.

After kidney-sparing management >5 yr

  • Perform urinary cytology and computed tomography urography at 3 and 6 mo, and then annually.

  • Perform cystoscopy, ureteroscopy, and cytology in situ at 3 and 6 mo, and then every 6 mo for 2 yr, and then annually.

For further reading, see Urothelial Tumors of the Renal Pelvis and Ureters

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