What are the guidelines on the diagnosis of urothelial tumors of the renal pelvis and ureters?

Updated: Aug 07, 2020
  • Author: Kyle A Richards, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The NCCN guidelines recommend including the following tests in the workup of suspected renal pelvic and ureteral tumors [23] :

  • Cystoscopy
  • CT or MR urography
  • Renal ultrasound or CT without contrast with retrograde pyelography
  • Ureteroscopy with biopsy and/or selective washings.
  • Chest x-ray to help evaluate for possible metastasis and assess for comorbidities
  • Urine cytology to help identify carcinoma cells
  • Hematologic, renal and hepatic function should be assessed

Additional imaging studies, such as renal or bone scanning, may be indicated by the test results or presence of specific symptoms. Evaluation for Lynch syndrome should be considered for those at high risk.

The EAU guidelines in general concur with NCCN and include the following key recommendations [1] :

  • Cystoscopy is performed to rule out concurrent bladder tumor
  • CT urography is performed for upper tract evaluation and staging
  • Diagnostic ureteroscopy and biopsy are performed only in cases where additional information will impact treatment decisions

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