Upper Urinary Tract Urothelial Cancer: Difference between revisions
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****#Avoid potential contamination in case of concomitant bladder and/or prostatic urethral disease | ****#Avoid potential contamination in case of concomitant bladder and/or prostatic urethral disease | ||
****#Avoid theoretical dilution of the specimen from a normal contralateral unit | ****#Avoid theoretical dilution of the specimen from a normal contralateral unit | ||
**'''In a patient with an upper tract filling defect and an abnormal voided cytology, must be cautious in determining the site of origin of the malignant cells'''. Ureteral catheterization for collection of urine or washings may provide more accurate cytologic results. | ***'''Voided cytology''' | ||
****'''In a patient with an upper tract filling defect and an abnormal voided cytology, must be cautious in determining the site of origin of the malignant cells'''. | |||
*****Ureteral catheterization for collection of urine or washings may provide more accurate cytologic results. | |||
==== <span style="color:#ff0000">Assessment of renal function</span> ==== | ==== <span style="color:#ff0000">Assessment of renal function</span> ==== | ||
*Can help with | *Can help with | ||
*#Patient counseling | |||
*#Strategizing treatment sequence (operative approach and administration of systemic therapy) | |||
*#Determination of downstream risks of CKD and potential dialysis | |||
* '''<span style="color:#ff0000">Recommended test: serum creatinine (to calculate an eGFR)''' | * '''<span style="color:#ff0000">Recommended test: serum creatinine (to calculate an eGFR)''' | ||
**The two formulas for monitoring eGFR commonly reported in the contemporary literature at this time are the [https://www.mdcalc.com/calc/76/mdrd-gfr-equation Modification of Diet in Renal Disease] and [https://www.mdcalc.com/calc/3939/ckd-epi-equations-glomerular-filtration-rate-gfr CKD – Epidemiology Collaboration (CKD-EPI)] equations. | |||
**For more refined evaluation, split function testing such as with differential renal scan or CT volumetric studies may be considered. | **For more refined evaluation, split function testing such as with differential renal scan or CT volumetric studies may be considered. | ||
*'''<span style="color:#ff0000">Special scenarios''' | |||
*'''<span style="color:#ff0000"> | **'''<span style="color:#ff0000">UTUC with associated hydronephrosis''' | ||
**''' | ***Tumor obstruction may falsely under-estimate preoperative renal function and alter decision-making around the use of neoadjuvant chemotherapy (NAC). | ||
*** | ***'''Renal decompression either by indwelling ureteric stent or a percutaneous nephrostomy tube placed in an uninvolved renal calyx along with oral fluid hydration for 7-14 days before re-checking eGFR will help to establish a more accurate estimation of baseline renal function.''' | ||
* | ****'''<span style="color:#ff0000">Ureteric stenting is the preferred method of drainage''' | ||
**'''Renal decompression either by indwelling ureteric stent or a percutaneous nephrostomy tube placed in an uninvolved renal calyx along with oral fluid hydration for 7-14 days before re-checking eGFR will help to establish a more accurate estimation of baseline renal function.''' | *****Percutaneous nephrostomy tubes in the setting of UTUC increases risk of tract seeding and has worse quality of life | ||
***'''<span style="color:#ff0000">Ureteric stenting is the preferred method of drainage''' | **'''Atrophy of the contralateral (unaffected) renal unit''' | ||
****Percutaneous nephrostomy tubes in the setting of UTUC increases risk of tract seeding and has worse quality of life | ***'''May lead to over-estimates of postoperative renal function in the setting of NU since the kidney with lower differential function will remain in situ''' | ||
=== Imaging === | === Imaging === | ||