Editing Upper Urinary Tract Urothelial Cancer (section)

=== Special Scenarios ===

==== Positive Upper Tract Urinary Cytology ====
* '''<span style="color:#ff0000">First, repeat the cytology to confirm the findings</span>'''
** '''Any source of inflammation, such as urinary infection or calculus, may produce a false-positive result'''
** A subsequent cytologic abnormality from the contralateral side during follow-up is not rare in cases of true-positive results from early CIS
* '''<span style="color:#ff0000">Next, radiographic evaluation of the upper tracts, usually with CT urography, and a complete bladder evaluation with cystoscopy</span>'''
** '''<span style="color:#ff0000">If the bladder evaluation was</span>'''
*** '''<span style="color:#ff0000">Positive for bladder tumour, treat the bladder and follow the voided urinary cytologies.</span>'''
**** If cytology remains positive despite a negative bladder evaluation or after successful treatment of the bladder, proceed to evaluating extravesical sites.
*** '''<span style="color:#ff0000">Negative for bladder tumour, evaluate extravesical sites.</span>'''
**** '''Evaluation of extravesical sites should include <span style="color:#ff0000">selective cytologies from each upper urinary tract,</span>''' ensuring non-contamination of the specimen from the bladder or urethra, '''as well as resection of a representative <span style="color:#ff0000">specimen of the prostatic urethra in men</span>'''.
***** Selective cytologies should preferably be done, along with ureteroscopy, to allow for direct visualization of the upper urinary tracts.
**** '''In cases of unilateral upper tract cytologic abnormalities''' (with normal cystoscopy, pyelography, and bladder biopsies), '''ureteropyeloscopy is indicated as the next step'''.
***** Ureteropyeloscopy allows for direct visualization of small lesions and is superior to retrograde pyelography in the detection of small tumors.
***** '''Biopsy at the time of ureteropyeloscopy should be attempted, if feasible. A persistently abnormal cytology without any visualized lesions may signify CIS'''.