Diagnosis and Prognostic Factors of UTUC
Preoperative tumor staging and diagnosis are difficult with currently available imaging modalities, but clinical variables have been identified to enable risk stratification and distinguish high-risk and low-risk tumors (Baard et al., Nat Rev Urol 14:181–
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Bum Sik Tae and Chang Wook Jeong
Contents 14.1 Symptom and Sign
151
14.2 Laboratory Finding 14.2.1 Urinalysis 14.2.2 Urine Cytology 14.2.3 Urinary Markers
152 152 153 153
14.3 Imaging 14.3.1 Computed Tomography 14.3.2 Magnetic Resonance Urography 14.3.3 Anterograde Pyelography, Retrograde Pyelography, and Sonography 14.3.4 Bone Scintigraphy
154 154 154 156 156
14.4 Endoscopic Evaluation 14.4.1 Cystoscopy 14.4.2 Ureteroscopy and Biopsy 14.4.3 Antegrade Endoscopy (Percutaneous Approach)
157 157 158 159
14.5 Prognostic Factor of Recurrence and Progression 14.5.1 Preoperative Factor 14.5.2 Postoperative Factor 14.5.3 Molecular Markers
159 159 161 162
References
165
14.1 Symptom and Sign
B. S. Tae Korea University College of Medicine, Seoul, South Korea Department Urology, Korea University Ansan Hospital, Ansan, South Korea C. W. Jeong (*) Department Urology, Seoul National University Hospital, Seoul, South Korea e-mail: [email protected]
Most common symptom of UTUC is hematuria, either gross or microscopic (70–80%) [1]. Flank pain is the second most common symptom, occurring in 20% of tumors, and a lumbar mass is present in approximately 10% [1]. Current pain is the result of ureteral obstruction from blood clots or tumor fragments, renal pelvic or ureteral obstruction by the tumor itself, or regional invasion by the tumor. It is known that flank pain in patients does not correlate with either locally advanced tumor
© Springer Nature Singapore Pte Ltd. 2019 J. H. Ku (ed.), Management of Urothelial Carcinoma, https://doi.org/10.1007/978-981-10-5502-7_14
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B. S. Tae and C. W. Jeong
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UTUC diagnosis
Imaging w/u CT or MRU
Cystoscopy and Urine cytology
Diagnostic ureteroscopy and biopsy
High risk
Risk assessment
Yes
Normal contralateral Kidney
RNU
Low risk
Kidney sparing treatment
No
Risk Assessment Low Risk
High Risk
Biopsy finding
Low grade
High grade
Urine cytology
Negative
Positive
Tumor size
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