The aim of the study is to report the reliability of computed tomography urography (CTU) and ureteroscopy (URS) in the diagnosis and management of UTUC.
From 2015 to 11/2018, we prospectively collected and retrospectively analyzed 244 cases of URS with available preoperative CTU. CTU was categorized as positive, suspicious, unlikely and negative. Correspondence between imaging, URS and histology was analyzed. The therapeutic indication, based on EAU Guidelines 2020 and patients' clinical data, was recorded before and after URS. Cohen's Kappa was used for agreement analysis. Logistic regression was used for prediction of positive URS.
URS was positive for UTUC in 107/115 (93%), 48/77 (62.3%), 15/27 (55.6%), 12/25 (48%) in positive, suspicious, unlikely, negative CTU, respectively. On cyto-histology, the result was confirmed in 164/182 (90.1%) cases. The PPV of a filling defect, stenosis, thickening and hydronephrosis on CTU was 87.7% (121/138), 65.6% (21/32), 69.6% (64/92) and 79.7% (59/74), respectively. On multivariate analysis, a filling defect (95% CI 2.76-11.5; OR=5.63; p<0.0001) or hydronephrosis (1.04-6.18; OR=2.52; p=0.04) were associated with URS outcome. Among cases with positive CTU and URS, the lesions differed in dimensions (20/107), number (14/107) and site (11/107) for a total of 45/107 (42.1%) cases. The indication of elective treatment changed after URS in 37/76 (48.1%) cases (Kappa=0.31), being respected 17/28 (60.7%), 11/20 (55%) and 11/28 (39.2%) cases for endoscopic management, ureterectomy and nephroureterectomy, respectively.
The complementary use of CTU and URS in the diagnostic work-up of UTUC should be evaluated.
The Journal of urology. 2020 Sep 16 [Epub ahead of print]
Andrea Gallioli, Angelo Territo, Asier Mercadé, Matteo Fontana, Romain Boissier, Josep Maria Gaya, Esteban Emiliani, Antoni Sánchez-Puy, Maria José Martínez, Joan Palou, Alberto Breda
Fundació Puigvert, Department of Urology, Autonomous University of Barcelona, Barcelona, Spain., Fundació Puigvert, Department of Radiology, Autonomous University of Barcelona, Barcelona, Spain.