Is Ureteroscopy Needed Prior to Nephroureterectomy? An Evidence-Based Algorithmic Approach
Aaron M Potretzke1, B Alexander Knight1, Theodora A Potretzke2
1Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
Urology
|November 8, 2015
Summary
An evidence-based approach suggests that ureteroscopy can be omitted in select upper tract urothelial carcinoma cases. This optimizes diagnostic workup by relying on sensitive noninvasive tests.
Area of Science:
- Urology
- Oncology
- Diagnostic Imaging
Background:
- Upper urinary tract lesions require accurate diagnosis.
- Establishing an evidence-based diagnostic workup is crucial.
Purpose of the Study:
- To develop an evidence-based diagnostic algorithm for suspicious upper urinary tract lesions.
- To evaluate the role of ureteroscopy in the diagnostic workup of upper tract urothelial carcinoma.
Main Methods:
- Systematic literature search of PubMed for upper tract urothelial carcinoma and related diagnostic terms.
- Review of 404 articles, with 33 selected for full review based on relevance.
- Development of a diagnostic algorithm based on available evidence.
Main Results:
- Computed tomography urogram demonstrates high sensitivity (96%) and specificity (99%).
- Cytology offers high specificity (89%-100%) for diagnosis.
- Ureteroscopy may be omitted in select cases due to the efficacy of noninvasive tests.
Conclusions:
- An evidence-based approach can refine the diagnostic workup for upper tract urothelial carcinoma.
- Ureteroscopy is not always necessary for diagnosing upper tract urothelial carcinoma.
- Optimized diagnostic strategies can improve patient management.
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