UPPER URINARY TRACT Aditya Airlangga

UROTHELIAL CARCINOMA
 TNM CLASSIFICATION 2017 FOR UROTHELIAL
CARCINOMA OF THE UPPER URINARY TRACT

EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma in EAU Guidelines, Edn. presented at the 34th EAU Annual Congress Barcelona. 2019, EAU Guidelines Office.
 DIAGNOSIS
Symptoms
 Haematuria - visible or nonvisible (70-80%)
 Flank pain (20%)
 Lumbar mass (10%)

Imaging
 Computed tomography urography (sensitivity 67–100% and specificity 93–99%)
 Magnetic resonance urography (sensitivity 75% after contrast injection for tumours < 2 cm)

Cystoscopy and urinary cytology

 Cytology is less sensitive for UTUC
 Retrograde ureteropyelography remains an option to detect UTUC

Diagnostic ureteroscopy
 Flexible ureteroscopy (URS) is used to visualise the ureter, renal pelvis and collecting system and for biopsy of suspicious lesions. Can determine tumour grade in
90% of cases

Distant metastasis
 Computed tomography and MRI are the diagnostic techniques of choice to detect lung and liver metastases

EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma in EAU Guidelines, Edn. presented at the 34th EAU Annual Congress Barcelona. 2019, EAU Guidelines Office.
 RISK STRATIFICATION

EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma in EAU Guidelines, Edn. presented at the 34th EAU Annual Congress Barcelona. 2019, EAU Guidelines Office.
 DISEASE MANAGEMENT
Localised disease
 Kidney-sparing surgery
 Radical nephroureterectomy
 Perioperative chemotherapy as an adjunct to radical nephroureterectomy
 Adjuvant Radiotherapy after radical nephroureterectomy
 Adjuvant bladder instillation

Metastatic disease
 Radical nephroureterectomy
 Metastasectomy
 Systemic treatments

EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma in EAU Guidelines, Edn. presented at the 34th EAU Annual Congress Barcelona. 2019, EAU Guidelines Office.
 LOCALISED DISEASE
Kidney-sparing surgery
 Ureteroscopy-Endoscopic ablation
 Percutaneous access
 Segmental ureteral resection-Lymphadenectomy can also be performed
 Upper urinary tract instillation of topical agents - BCG vaccine or mitomycin C in the UUT by percutaneous nephrostomy

Radical nephroureterectomy
 Open radical nephroureterectomy
 Laparoscopic radical nephroureterectomy
 Lymph node dissection

Perioperative chemotherapy as an adjunct to radical nephroureterectomy

 Neoadjuvant chemotherapy
 Adjuvant chemotherapy

Adjuvant Radiotherapy after radical nephroureterectomy

Adjuvant bladder instillation

EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma in EAU Guidelines, Edn. presented at the 34th EAU Annual Congress Barcelona. 2019, EAU Guidelines Office.