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Urothelial Tumors of the Renal Pelvis and Ureters Workup

  • Author: David F Jarrard, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Dec 23, 2014
 

Laboratory Studies

Urinalysis should be performed to confirm hematuria and to rule out a coexistent urinary tract infection.

Basic metabolic panel should be ordered to check serum creatinine (assess renal function) and electrolytes.

Activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR) should be ordered to check baseline coagulation status.

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Imaging Studies

Excretory urography is commonly referred to as intravenous pyelography (IVP). IVP is used to evaluate the upper urothelial tract. Its use has been primarily replaced with computed tomography (CT). Approximately 50-75% of patients with urothelial tumors of the renal pelvis and ureters have a radiolucent filling defect that is characteristically irregular and in continuity with the wall of the collecting system. See the image below. Approximately 10-30% of such tumors cause obstruction or nonvisualization of the collecting system.

Intravenous pyelogram (IVP) demonstrating an upper Intravenous pyelogram (IVP) demonstrating an upper calyx filling defect characteristic of transitional cell carcinoma (TCC). Blunting of the involved calyx is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.

Noncontrast CT scanning can be performed, followed by a contrast study, with particular interest in the excretory phase — a so-called CT urogram. Plain radiography, which demonstrates drainage and anatomy, can also be performed after CT scanning. Transitional cell carcinomas (TCCs) are usually present as an irregular filling defect. They tend to be hypovascular when compared with the rest of the kidney and demonstrate minimal increased attenuation (enhancement) following intravenous contrast injection. See the images below.

CT scan demonstrating right renal pelvis transitio CT scan demonstrating right renal pelvis transitional cell carcinoma (TCC). Contrast in the renal pelvis is displaced by the tumor. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating left distal ureteral transit CT scan demonstrating left distal ureteral transitional cell carcinoma (TCC). The left ureter is dilated and a medial filling defect is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.

CT scanning sensitivities and specificities based on lesion size are as follows:

  • For lesions 5-10 mm in size - 96% sensitivity and 99% specificity
  • For lesions smaller than 5 mm in size - 89% sensitivity
  • For lesions smaller than 3 mm in size - 40% sensitivity

CT scanning has limited value in staging TCC because stage Ta or superficial lesions cannot be differentiated from T2 or invasive lesions (see Staging). However, CT scanning is helpful in demonstrating peripelvic or periureteral tumor extension, thereby assisting with staging of aggressive disease. Hydronephrosis and obstruction are associated with a higher degree of invasiveness.

As with CT scanning, MRI is also of limited use in staging early TCC; however, it may have greater utility in more advanced disease or in patients with limited renal function.

There is interest in fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET)/CT for staging in TCC, but, at present, this study does not appear to have significant advantages over MRI.

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Other Tests

Cytopathology of voided urine samples yields low sensitivity, especially for low-grade tumors, which results in normal cytology results in up to 80% of cases. The sensitivity of cytopathology increases for higher-grade tumors, which tend to shed more tumor cells. Cytology yields an accuracy of 83% in patients with high-grade disease. Cytology is less sensitive for upper tract transitional cell carcinoma (TCC) than for bladder cancer. Cytology samples should be taken from as near the suspected lesion as possible (ie, within the calyceal system). Positive cytology has been related to more advanced (invasive) disease.[13] Selective washings of both the upper tracts and the bladder can aid in tumor localization. Cytology plays a role in urothelial tumor surveillance in conjunction with cystoscopy/ureteroscopy.

Fluorescence in situ hybridization (FISH) can be performed using probes for altered genes on chromosomes 3, 7, 17, and 9p21. FISH (UroVysion) is a useful test for detecting urinary tract cancer, as it yields a greater sensitivity for lower-grade tumors than cytology and other tests (as high as 76.6-100% vs 21-24% for cytology).[14, 15] Ureteral cancer has been detected with FISH during evaluation for hematuria.[16] FISH has equal specificity when compared with cytology (as high as 100%).

Ureteroscopy can be used for direct visualization of a tumor. Important to note is that it can be used to obtain tissue for a diagnosis and grade in 90% of cases.[17] Staging information regarding depth of invasion, however, is more difficult to obtain.

A preliminary study by Gayed et al concluded that assessment of cell cycle biomarkers obtained from endoscopic biopsy specimens may be useful in individualizing treatment regimens and determining prognosis in patients with upper tract urothelial cancer. In their study of 17 patients, a prognostic score was calculated on the basis of immunohistochemical expression of five biomarkers: p21, p27, p53, cyclin E, and Ki67/pRb, with an unfavorable score defined as more than two altered markers. An overall concordance rate of 60% was seen between biopsy results and findings on subsequent radical nephroureterectomy or segmental ureterectomy.[18]

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Diagnostic Procedures

Each of the following should be obtained in a suspected case of upper tract TCC: cystoscopy to rule out bladder tumor, urinary cytology, and CT urography.

For cystoscopy, a small fiberoptic scope is inserted through the urethra in order to visualize the bladder. This ambulatory/clinical procedure is usually well tolerated by both women and men. A 16F flexible cystoscope is typically used in men, whereas women can undergo either rigid or flexible cystoscopic examination. This procedure is mandatory to rule out coexistent bladder lesions, which occur with a frequency of 8-13%.[1] Cystoscopy is also essential for postoperative surveillance to monitor for bladder tumor development; recurrence in the bladder occurs 15-51% of patients.[19]

In retrograde urography (see image below), contrast is injected into the ureteral orifice with the aid of a cystoscope. This can be performed with fluoroscopic guidance or with standard radiography plates. Retrograde urography allows better visualization of the collecting system than excretory urography by increasing the distention of the urinary collecting system. Retrograde pyelography is preferable in patients with azotemia and/or contrast allergy. Overall, retrograde urography is more than 75% accurate in establishing a diagnosis of urothelial cancer.

Left retrograde ureterogram demonstrating the clas Left retrograde ureterogram demonstrating the classic "goblet" sign of ureteral transitional cell carcinoma (TCC). Ureteral dilation distally and proximally to the tumor is present. The narrowed wall of the ureter is irregular. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.

Since the advent of rigid and flexible ureteroscopes, ureteropyeloscopy is used increasingly for the diagnosis of upper tract urothelial tumors. Biopsy forceps or cytology brushings can be used to collect tissue. This procedure yields an accuracy of 86% in diagnosing renal pelvis tumors and 90% in diagnosing ureteral tumors. Large size, broad base, and nonpapillary pattern favor tumor invasiveness. Studies have demonstrated that 85% of TCC lesions in the renal pelvis are papillary. The complication rate associated with ureteropyeloscopy is approximately 7%; these include perforation, complete disruption, and ureteral stricture.

Percutaneous nephroscopy is not indicated for the diagnosis of urothelial tumors of the renal pelvis and ureters because of the theoretical risk of tumor cell implantation in the retroperitoneum and nephrostomy tube tract. It is used for treatment in selected situations.

Nevertheless, Huang et al concluded that percutaneous biopsy is safe and effective for diagnosis of upper tract urothelial lesions that are not amenable to endoscopic biopsy. In their study of 26 upper tract lesions in 24 patients, percutaneous biopsy provided tissue diagnosis in 85% of cases; the three recurrences in the nephrectomy bed developed at sites remote from the biopsy site and thus were not attributed to tract seeding.[20]

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Staging

The distribution of tumor stages and grades differs from study to study. Stage and grade yield the greatest prognostic value.

Grading, based on the 2004 World Health Organization (WHO) classification, is as follows:

  • Grade 1 - Papillary urothelial neoplasia of low malignant potential
  • Grade 2 - Low-grade carcinoma
  • Grade 3 - High-grade carcinoma

Staging, based on the depth of tumor invasion and classified using the tumor, node, metastases (TNM) system (2009), is as follows:

  • Tis - Carcinoma in situ
  • Ta - Superficial/papillary, noninvasive
  • T1 - Lamina propria invasion
  • T2 - Muscularis propria invasion
  • T3 – Peripelvic fat/periureteral fat/renal parenchyma invasion
  • T4 - Contiguous organ involvement
  • N0 - Negative nodes
  • N1 - Metastasis in single node less than 2 cm in diameter
  • N2 - Metastasis in single node 2-5 cm in diameter or metastasis to multiple nodes less than 5 cm in diameter
  • N3 - Metastasis in lymph node greater than 5 cm in diameter
  • M0 - No distant metastasis
  • M1 - Distant metastasis

The location of the tumor can affect the findings. Renal pelvis tumors are more commonly invasive than bladder tumors, possibly because of delayed diagnosis and a less well-developed muscle layer.

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Contributor Information and Disclosures
Author

David F Jarrard, MD Professor of Urology and Molecular and Environmental Toxicology, University of Wisconsin School of Medicine and Public Health

David F Jarrard, MD is a member of the following medical societies: American Urological Association

Disclosure: Received consulting fee from Johnson and Johnson for consulting.

Coauthor(s)

Tracy Downs, MD Associate Professor of Urology, University of Wisconsin School of Medicine and Public Health

Tracy Downs, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, Society of Urologic Oncology

Disclosure: Nothing to disclose.

Aaron M Potretzke, MD Resident Physician, Department of Urology, University of Wisconsin Hospital and Clinics

Aaron M Potretzke, MD is a member of the following medical societies: American Medical Association, Minnesota Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Gabriel Gomella, MD, FACS The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, Society of Urologic Oncology

Disclosure: Received consulting fee from GSK for consulting; Received honoraria from Astra Zeneca for speaking and teaching; Received consulting fee from Watson Pharmaceuticals for consulting.

Acknowledgements

Daniel M Kaplon, MD Fellow in Endourology, Laparoscopy, and Robotics, Department of Urology, University of Wisconsin Medical School

Disclosure: Nothing to disclose.

John N Papadopoulos, MD Resident Physician, Department of Urology, Veterans Administration Hospital and Meriter Hospital

Disclosure: Nothing to disclose.

Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center

Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology

Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

Michael N Wilkin, MD Staff Physician, Division of Urology, University of Wisconsin Hospital and Clinics

Disclosure: Nothing to disclose.

References
  1. [Guideline] Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester R, Burger M, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013 Jun. 63(6):1059-71. [Medline].

  2. Shih C, Hotaling JM, Wright JL, White E. Long-term NSAID use and incident urothelial cell carcinoma in the VITamins and Lifestyle (VITAL) study. Urol Oncol. 2012 Jul 11. [Medline].

  3. Raman JD, Scherr DS. Management of patients with upper urinary tract transitional cell carcinoma. Nat Clin Pract Urol. 2007 Aug. 4(8):432-43. [Medline].

  4. Rouprêt M, Fromont G, Azzouzi AR, Catto JW, Vallancien G, Hamdy FC. Microsatellite instability as predictor of survival in patients with invasive upper urinary tract transitional cell carcinoma. Urology. 2005 Jun. 65(6):1233-7. [Medline].

  5. Roupret M, Catto J, Coulet F, Azzouzi AR, Amira N, Karmouni T. Microsatellite instability as indicator of MSH2 gene mutation in patients with upper urinary tract transitional cell carcinoma. J Med Genet. 2004 Jul. 41(7):e91. [Medline].

  6. Eltz S, Comperat E, Cussenot O, Rouprêt M. Molecular and histological markers in urothelial carcinomas of the upper urinary tract. BJU Int. 2008 Aug 5. 102(5):532-5. [Medline].

  7. Jeon HG, Jeong IG, Bae J, Lee JW, Won JK, Paik JH. Expression of Ki-67 and COX-2 in patients with upper urinary tract urothelial carcinoma. Urology. 2010 Aug. 76(2):513.e7-12. [Medline].

  8. Leibl S, Zigeuner R, Hutterer G, Chromecki T, Rehak P, Langner C. EGFR expression in urothelial carcinoma of the upper urinary tract is associated with disease progression and metaplastic morphology. APMIS. 2008 Jan. 116(1):27-32. [Medline].

  9. Jeong IG, Kim SH, Jeon HG, Kim BH, Moon KC, Lee SE. Prognostic value of apoptosis-related markers in urothelial cancer of the upper urinary tract. Hum Pathol. 2009 May. 40(5):668-77. [Medline].

  10. Lughezzani G, Burger M, Margulis V, Matin SF, Novara G, Roupret M. Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol. 2012 Jul. 62(1):100-14. [Medline].

  11. Smith SD, Wheeler MA, Plescia J, Colberg JW, Weiss RM, Altieri DC. Urine detection of survivin and diagnosis of bladder cancer. JAMA. 2001 Jan 17. 285(3):324-8. [Medline].

  12. Sanderson KM, Cai J, Miranda G, Skinner DG, Stein JP. Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup. J Urol. 2007 Jun. 177(6):2088-94. [Medline].

  13. Brien JC, Shariat SF, Herman MP, Ng CK, Scherr DS, Scoll B. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol. 2010 Jul. 184(1):69-73. [Medline].

  14. Luo B, Li W, Deng CH, Zheng FF, Sun XZ, Wang DH. Utility of fluorescence in situ hybridization in the diagnosis of upper urinary tract urothelial carcinoma. Cancer Genet Cytogenet. 2009 Mar. 189(2):93-7. [Medline].

  15. Mian C, Mazzoleni G, Vikoler S, Martini T, Knuchel-Clark R, Zaak D. Fluorescence in situ hybridisation in the diagnosis of upper urinary tract tumours. Eur Urol. 2010 Aug. 58(2):288-92. [Medline].

  16. Sarosdy MF, Kahn PR, Ziffer MD, Love WR, Barkin J, Abara EO. Use of a multitarget fluorescence in situ hybridization assay to diagnose bladder cancer in patients with hematuria. J Urol. 2006 Jul. 176(1):44-7. [Medline].

  17. Tavora F, Fajardo DA, Lee TK, Lotan T, Miller JS, Miyamoto H. Small endoscopic biopsies of the ureter and renal pelvis: pathologic pitfalls. Am J Surg Pathol. 2009 Oct. 33(10):1540-6. [Medline].

  18. Gayed BA, Bagrodia A, Gaitonde M, Krabbe LM, Meissner M, Kapur P, et al. Feasibility of obtaining biomarker profiles from endoscopic biopsy specimens in upper tract urothelial carcinoma: Preliminary results. Urol Oncol. 2015 Jan. 33(1):18.e21-6. [Medline].

  19. Azemar MD, Comperat E, Richard F, Cussenot O, Roupret M. Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol. 2011 Mar-Apr. 29(2):130-6. [Medline].

  20. Huang SY, Ahrar K, Gupta S, Wallace MJ, Ensor JE, Krishnamurthy S, et al. Safety and diagnostic accuracy of percutaneous biopsy in upper tract urothelial carcinoma. BJU Int. 2014 Jun 6. [Medline].

  21. Cutress ML, Stewart GD, Zakikhani P, Phipps S, Thomas BG, Tolley DA. Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. BJU Int. 2012 Sep. 110(5):614-28. [Medline].

  22. Hayashida Y, Nomata K, Noguchi M, Eguchi J, Koga S, Yamashita S. Long-term effects of bacille Calmette-Guérin perfusion therapy for treatment of transitional cell carcinoma in situ of upper urinary tract. Urology. 2004 Jun. 63(6):1084-8. [Medline].

  23. Audenet F, Traxer O, Bensalah K, Roupret M. Upper urinary tract instillations in the treatment of urothelial carcinomas: a review of technical constraints and outcomes. World J Urol. 2012 Sep 25. [Medline].

  24. Keeley FX Jr, Bagley DH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol. 1997 Dec. 158(6):2074-7. [Medline].

  25. O'Brien T, Ray E, Singh R, Coker B, Beard R. Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol. 2011 Oct. 60(4):703-10. [Medline].

  26. See WA. Continuous antegrade infusion of adriamycin as adjuvant therapy for upper tract urothelial malignancies. Urology. 2000 Aug 1. 56(2):216-22. [Medline].

  27. Audenet F, Yates DR, Cussenot O, Roupret M. The role of chemotherapy in the treatment of urothelial cell carcinoma of the upper urinary tract (UUT-UCC). Urol Oncol. 2010 Sep 28. [Medline].

  28. Hellenthal NJ, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C. Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol. 2009 Sep. 182(3):900-6. [Medline].

  29. Matin SF, Margulis V, Kamat A, Wood CG, Grossman HB, Brown GA. Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer. 2010 Jul 1. 116(13):3127-34. [Medline].

  30. Czito B, Zietman A, Kaufman D, Skowronski U, Shipley W. Adjuvant radiotherapy with and without concurrent chemotherapy for locally advanced transitional cell carcinoma of the renal pelvis and ureter. J Urol. 2004 Oct. 172(4 Pt 1):1271-5. [Medline].

  31. Galsky MD, Hahn NM, Rosenberg J, Sonpavde G, Hutson T, Oh WK. Treatment of patients with metastatic urothelial cancer "unfit" for Cisplatin-based chemotherapy. J Clin Oncol. 2011 Jun 10. 29(17):2432-8. [Medline].

  32. de Sa VK, Canavez FC, Silva IA, Srougi M, Leite KR. Isoforms of hyaluronidases can be a predictor of a prostate cancer of good prognosis. Urol Oncol. 2009 Jul-Aug. 27(4):377-81. [Medline].

  33. Morales-Barrera R, Bellmunt J, Suarez C, Valverde C, Guix M, Serrano C. Cisplatin and gemcitabine administered every two weeks in patients with locally advanced or metastatic urothelial carcinoma and impaired renal function. Eur J Cancer. 2012 Aug. 48(12):1816-21. [Medline].

  34. Lughezzani G, Sun M, Perrotte P, Shariat SF, Jeldres C, Budaus L. Should bladder cuff excision remain the standard of care at nephroureterectomy in patients with urothelial carcinoma of the renal pelvis? A population-based study. Eur Urol. 2010 Jun. 57(6):956-62. [Medline].

  35. Li WM, Shen JT, Li CC, Ke HL, Wei YC, Wu WJ. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010 Jun. 57(6):963-9. [Medline].

  36. Simone G, Papalia R, Guaglianone S, Ferriero M, Leonardo C, Forastiere E. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol. 2009 Sep. 56(3):520-6. [Medline].

  37. Waldert M, Remzi M, Klingler HC, Mueller L, Marberger M. The oncological results of laparoscopic nephroureterectomy for upper urinary tract transitional cell cancer are equal to those of open nephroureterectomy. BJU Int. 2009 Jan. 103(1):66-70. [Medline].

  38. Rai BP, Shelley M, Coles B, Somani B, Nabi G. Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review. BJU Int. 2012 Nov. 110(10):1426-35. [Medline].

  39. Jeldres C, Lughezzani G, Sun M, Isbarn H, Shariat SF, Budaus L. Segmental ureterectomy can safely be performed in patients with transitional cell carcinoma of the ureter. J Urol. 2010 Apr. 183(4):1324-9. [Medline].

  40. Cutress ML, Stewart GD, Wells-Cole S, Phipps S, Thomas BG, Tolley DA. Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJU Int. 2012 May 7. [Medline].

  41. Krambeck AE, Thompson RH, Lohse CM, Patterson DE, Segura JW, Zincke H. Endoscopic management of upper tract urothelial carcinoma in patients with a history of bladder urothelial carcinoma. J Urol. 2007 May. 177(5):1721-6. [Medline].

  42. Grasso M, Fishman AI, Cohen J, Alexander B. Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15-year comprehensive review of 160 consecutive patients. BJU Int. 2012 Mar 28. [Medline].

  43. Nakada SY, Pearle MS. Totowa, NJ. Advanced endourology : the complete clinical guide. Humana Press; 2006. 154(5):

  44. Lucas SM, Svatek RS, Olgin G, Arriaga Y, Kabbani W, Sagalowsky AI. Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int. 2008 Jul. 102(2):172-6. [Medline].

  45. Gadzinski AJ, Roberts WW, Faerber GJ, Wolf JS Jr. Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol. 2010 Jun. 183(6):2148-53. [Medline].

  46. Silberstein JL, Power NE, Savage C, Tarin TV, Favaretto RL, Su D. Renal function and oncologic outcomes of parenchymal sparing ureteral resection versus radical nephroureterectomy for upper tract urothelial carcinoma. J Urol. 2012 Feb. 187(2):429-34. [Medline].

  47. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol. 2007 Oct. 178(4 Pt 1):1212-7; discussion 1217. [Medline].

  48. Chen GL, El-Gabry EA, Bagley DH. Surveillance of upper urinary tract transitional cell carcinoma: the role of ureteroscopy, retrograde pyelography, cytology and urinalysis. J Urol. 2000 Dec. 164(6):1901-4. [Medline].

  49. Siemens DR, Morales A, Johnston B, Emerson L. A comparative analysis of rapid urine tests for the diagnosis of upper urinary tract malignancy. Can J Urol. 2003 Feb. 10(1):1754-8. [Medline].

  50. Abouassaly R, Alibhai SM, Shah N, Timilshina N, Fleshner N, Finelli A. Troubling outcomes from population-level analysis of surgery for upper tract urothelial carcinoma. Urology. 2010 Oct. 76(4):895-901. [Medline].

  51. Rink M, Sjoberg D, Comploj E, Margulis V, Xylinas E, Lee RK. Risk of Cancer-specific Mortality following Recurrence After Radical Nephroureterectomy. Ann Surg Oncol. 2012 Jul 18. [Medline].

  52. Guarnizo E, Pavlovich CP, Seiba M, Carlson DL, Vaughan ED Jr, Sosa RE. Ureteroscopic biopsy of upper tract urothelial carcinoma: improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach. J Urol. 2000 Jan. 163(1):52-5. [Medline].

  53. Lughezzani G, Jeldres C, Isbarn H, Sun M, Shariat SF, Alasker A. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer. 2009 Dec. 45(18):3291-7. [Medline].

  54. Chromecki TF, Ehdaie B, Novara G, et al. Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy. World J Urol. 2011. 29:473-80.

  55. Raman JD, Messer J, Sielatycki JA, Hollenbeak CS. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973-2005. BJU Int. 2011 Apr. 107(7):1059-64. [Medline].

  56. Berod AA, Colin P, Yates DR, Ouzzane A, Audouin M, Adam E. The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi-institutional collaborative study. BJU Int. 2012 May 8. [Medline].

  57. Rink M, Xylinas E, Margulis V, Cha EK, Ehdaie B, Raman JD. Impact of Smoking on Oncologic Outcomes of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy. Eur Urol. 2012 Jun 22. [Medline].

  58. Ito Y, Kikuchi E, Tanaka N, Miyajima A, Mikami S, Jinzaki M. Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol. 2011 May. 185(5):1621-6. [Medline].

  59. Ng CK, Shariat SF, Lucas SM, Bagrodia A, Lotan Y, Scherr DS. Does the presence of hydronephrosis on preoperative axial CT imaging predict worse outcomes for patients undergoing nephroureterectomy for upper-tract urothelial carcinoma?. Urol Oncol. 2011 Jan-Feb. 29(1):27-32. [Medline].

  60. Ehdaie B, Chromecki TF, Lee RK, Lotan Y, Margulis V, Karakiewicz PI. Obesity adversely impacts disease specific outcomes in patients with upper tract urothelial carcinoma. J Urol. 2011 Jul. 186(1):66-72. [Medline].

  61. Kikuchi E, Margulis V, Karakiewicz PI, Roscigno M, Mikami S, Lotan Y. Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol. 2009 Feb 1. 27(4):612-8. [Medline].

  62. Larre S, Camparo P, Comperat E, et al. Diagnostic, staging, and grading of urothelial carcinomas from urine: performance of BCA-1, a mini-array comparative genomic hybridisation-based test. Eur Urol. 2011 Feb. 59(2):250-7. [Medline].

 
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Intravenous pyelogram (IVP) demonstrating an upper calyx filling defect characteristic of transitional cell carcinoma (TCC). Blunting of the involved calyx is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating right renal pelvis transitional cell carcinoma (TCC). Contrast in the renal pelvis is displaced by the tumor. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating left distal ureteral transitional cell carcinoma (TCC). The left ureter is dilated and a medial filling defect is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
Left retrograde ureterogram demonstrating the classic "goblet" sign of ureteral transitional cell carcinoma (TCC). Ureteral dilation distally and proximally to the tumor is present. The narrowed wall of the ureter is irregular. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating bulky right renal pelvis transitional cell carcinoma (TCC) replacing the majority of the renal parenchyma. A pericaval lymph node metastasis is noted. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
CT scan demonstrating metastatic transitional cell carcinoma (TCC) of the right adrenal gland. A heterogeneous adrenal mass is noted adjacent to the spine. The superior portion of the right kidney is observed. Courtesy of Andrew J. Taylor, MD, University of Wisconsin Medical School.
 
 
 
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