Commentary: Ureteral pseudodiverticulosis is diagnosable on computed tomography
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SPECIAL SECTION: UROTHELIAL DISORDERS
Commentary: Ureteral pseudodiverticulosis is diagnosable on computed tomography Neil F. Wasserman1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Ureteral pseudodiverticula or ureteral diverticulosis (UPD) is a rare condition of unknown etiology wherein one or multiple outpouchings ≤ 4 mm are visible on diagnostic imaging [1]. Its importance lies in the fact that it has a high association with uroepithelial cancer, mostly transitional cell carcinoma (TCC), at the time of the latter’s diagnosis [1, 2]. UPD has been reported in imaging studies to antedate the diagnosis of urinary tract cancer anywhere from 2 to 10 years [3]. A recently published article in this journal by Morgan et al. [4] attempts to explore the longer-term need to clinically follow up patients presenting with UPD without diagnosable uroepithelial cancer and those with UPD associated with cancer at the time of cancer diagnosis. What are the downstream risks, and do those in the former group require careful clinical follow-up? It is current practice for urologists to follow all patients with proved uroepithelial cancer whether or not they presented with UPD. Discussion of how to follow those with UPD without cancer is ongoing. To their credit, Morgan et al. followed matched UPD groups presenting with and without carcinoma. Their study is about as well designed as one could expect for a retrospective examination, but it is limited in follow-up to a mean of 7.5 years. (With a range of 1–16 years, the median followup period might have provided a better measure of length.) They suggested that there is “no need for increased followup in patients presenting with no known (urothelial cell carcinoma) and pseudodiverticulosis on imaging.” That could be true, but we may have to wait for a confirming longer median follow-up and/or a prospective study to be certain.
* Neil F. Wasserman [email protected] 1
Department of Radiology, University of Minnesota, Minneapolis, MN, USA
Department of Radiology, University of Minnesota Medical School, Mayo Mail Code 292, 420 Delaware Street S.E., Minneapolis, MN 55455, USA
2
In addition, their findings may only apply to their specific patient population, which was not completely characterized in terms of smoking history, occupational exposure to carcinogenic hydrocarbons, analgesics, exposure to schistosomiasis, race, and ethnicity in their article. Risk of developing TCC is likely related to the preceding extrinsic factors as well as genetic intrinsic factors [5]. The authors might have considered using propensity-matching in their experimental design to mitigate selection bias [6]. The largest previously reported series of UPD cases was reported in a population of military veterans who have a high prevalence of heavy smoking [1, 2]. Morgan et al. also state in their introduction that UPDs are “generally thought to be below the level of spatial resolution of CT urography” performed with multidetector computed tomography. As was pointed out in their
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