Urothelial Tumors of the

Upper Urinary Tract and

Ureter
{ Maj. Hafiz
  EPIDEMIOLOGY
 RISK FACTORS
 HISTOPATHOLOGY
 DIAGNOSIS
 STAGING AND
CLASSIFICATION
 PROGNOSIS

CONTENT
EPIDEMIOLOGY
RISK FACTORS
HISTOPATHOLOGY
 The common symptoms include hematuria, dysuria, and
flank pain, which are usually related to localized disease.
 Hematuria is the most common sign of the UTUCs and could
be either gross or microscopic.
 Flank pain represents the second most frequent symptom
 A lumbar mass could also be palpated in approximately 10%
cases

DIAGNOSIS
 Endoscopy of the Lower Tract-
 Cystoscopy should always be performed because the upper
urinary tract tumors are often associated with bladder cancer.
During
 Endoscopy of the Upper Tract-
 Flexible ureteroscopy (URS) is the key approach for the
visualization of the ureter, renal pelvis, and collecting system.
 The biopsy of suspicious lesions could also be done with
URS.
 Antegrade Endoscopic Evaluation
 Antegrade nephroscopy, ureteroscopy, and urography could
be useful for visualization, biopsy, or even tumor resection.

DIAGNOSIS
 Radiologic Imaging
 Computed tomographic (CT) urography has the highest
diagnostic accuracy of the available imaging techniques
 Magnetic resonance (MR) urography is indicated in patients
to whom the radiation or iodinated contrast media are
contraindicated and cannot undergo CT urography
 Gadolinium-based contrast media for MR urography should
be limited in patients with severe renal impairment (<30
mL/min creatinine clearance).
 Evaluation of the contralateral kidney is important not only
because of possible bilateral presence of the disease but also
because it allows a determination of the functionality of the
contralateral kidney.

DIAGNOSIS
 Cytology and Tumor Markers
 Urine cytology could be used for the diagnosis of upper
urinary tract tumors. Nevertheless, the sensitivity of voided
urine (or bladder wash) cytology remains low and is related
to the grade of the tumor.

DIAGNOSIS
STAGING AND CLASSIFICATION
STAGING AND CLASSIFICATION
STAGING AND CLASSIFICATION
PROGNOSIS
PROGNOSIS
 QUSTION?
THANK YOU

CONCLUSION