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
Medscape © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, September 2017 - Medscape - Sep 15, 2017.
