Urol. praxi. 2020;21(1):16-22 | DOI: 10.36290/uro.2019.081

Upper tract urothelial carcinomas

doc. MUDr. Jozef Marenčák, PhD.

Bratislava

Upper tract urothelial carcinomas (UTUCs) are relatively uncommon and comprises 5-10 % of all urothelial tumors. Etiology and natural history of UTUCs is similar to that of urothelial cell carcinomas in bladder. Histologically, the most renal pelvic and ureteral cancers are transitional cell carcinomas. There are many risk factors for UTUCs, including environmental and genetic risk factors. Most common symptom of UTUCs is hematuria, either gross or microscopic (70-80 %), flank pain (in 20 % of tumors) and a lumbar mass (present in approximately 10 %). CT urography (CTU) has become the imaging modality of choice for evaluation of UTUC. Advancements in endoscopic techniques have aided in the diagnosis, grading and treatment of this disease. Treatment options include many modalities. The gold standard surgical management of UTUCs is radical nephroureterectomy (RNU) with excision of bladder cuff, which is increasingly being performed laparoscopically or robotically with various methods use for distal ureter. There are increasing numbers of patients being treated endoscopically, with excellent oncological outcomes in low (favourable) grade disease. The use of topical chemotherapy agents has been extrapolated from bladder cancer and may be an adjunct to endoscopic management in those patients in whom it is imperative to avoid RNU.

Keywords: upper tract urothelial carcinoma, epidemiology, risk factors, diagnosis, treatment, prognosis.

Received: October 23, 2019; Revised: October 23, 2019; Accepted: November 29, 2019; Prepublished online: November 29, 2019; Published: April 17, 2020  Show citation