Epidemiology, Clinical Presentation, and Evaluation of Upper-Tract Urothelial Carcinoma

Firas G. Petros


Transl Androl Urol. 2020;9(4):1794-1798. 

In This Article

Diagnosis: Clinical Presentation and Evaluation

Clinical Presentation

The most common presenting symptom in two third of patients with UTUC is either gross or microscopic hematuria[35] whereas 25% of patients present with flank pain secondary to obstruction of either the kidney and/or the ureter by upper tract tumor.[3] Findings of hydronephrosis on preoperative imaging can be seen in 37% to 80% of patients. Studies have suggested the presence of preoperative hydronephrosis is prognostic indicator for advanced disease and this information may impact decision for neoadjuvant chemotherapy as well as extent of radical resection.[36,37] Less commonly, patients may present with a flank mass[3] and rarely, UTUC found incidentally on imaging and these patients are asymptomatic at diagnosis. The presence of constitutional symptoms of weight loss, anorexia, fatigue, malaise, fever, night sweats and cough associating UTUC should trigger a thorough metastatic workup since these symptoms predict worse outcome.[3]

Clinical Evaluation

The clinical assessment of patients thought to have UTUC should start with history evaluating risk factors and physical examination including abdominal exam. Workup including microscopic urinalysis to detect microscopic hematuria ruling out concomitant urinary tract infection, urine cytology, laboratory tests including hemoglobin level and renal function, and upper tract axial imaging with CT or MR urography, or renal ultrasound, CT/MR without contrast and retrograde pyelography if iodinated or gadolinium-based contrast are contraindicated. Nuclear renogram might also be obtained if indicated. Ultimately, cystoscopy, ureteroscopy with biopsy can be pursued.