Ureteropyeloscopy in the evaluation of upper tract filling defects

We studied prospectively 12 patients with upper tract filling defects to determine the clinical value of ureteropyeloscopy in this setting. All of the patients underwent a standard diagnostic regimen, including cystoscopy and retrograde pyelography, at which time upper tract cytology studies were obtained with or without saline lavage or brushings. Computerized tomography scans or ultrasonography also was obtained when indicated. Ureteropyeloscopy with or without transureteroscopic biopsy then was performed. An operation was done when clinically indicated and a definitive diagnosis ultimately was available in all cases. The provisional diagnosis from the standard diagnostic regimen was accurate in 7 of the patients (58 per cent), while the results of ureteropyeloscopy proved to be correct in 10 (83 per cent). Ureteropyeloscopy appears to be more accurate than a standard diagnostic regimen in the evaluation of upper tract filling defects and we recommend its inclusion as a routine part of the evaluation of these patients.