Routine diagnostic ureteroscopy for suspected upper tract transitional-cell carcinoma

Area of Science:

• Urology
• Oncology
• Diagnostic Imaging

Background:

• Upper tract transitional-cell carcinoma (utTCC) is rare.
• Standard evaluation involves imaging, cytology, and cystoscopy, with nephroureterectomy (NU) as the gold standard treatment.
• NU offers solid oncologic outcomes but carries significant morbidity.

Purpose of the Study:

• To evaluate the impact of routine ureteroscopy (URS) in diagnosing suspected utTCC.
• To assess URS's role in shifting treatment towards less morbid options.
• To determine if routine URS improves preoperative diagnostic accuracy.

Main Methods:

• Retrospective review of patients with suspected utTCC between 2002 and 2013.
• Comparison of outcomes between patients evaluated before (group 1) and after (group 2) routine URS implementation (since 2010).
• Calculation of number needed to treat (NNT) for treatment shifts and reduction in misdiagnoses.

Main Results:

• 118 patients included; pathology-confirmed TCC rates were similar (78% vs 85%).
• Routine URS use decreased NU rates from 89% to 69% (P=0.011, NNT=5.05).
• Misdiagnoses significantly reduced from 15.5% to 2.1% with routine URS (P=0.021, NNT=7.44).
• Two cases of sepsis occurred post-URS.

Conclusions:

• Routine URS for suspected utTCC facilitates alternative, less morbid treatments over NU.
• An estimated five URS procedures can avoid one NU.
• Routine URS significantly enhances diagnostic accuracy for utTCC, though potential complications exist.