title: The role of diagnostic ureteroscopy in the era of computed tomography urography.
abstract: BACKGROUND
  To examine the contemporary role of ureteroscopy in the diagnosis of upper urinary tract urothelial carcinoma.
  
  
  METHODS
  We retrospectively evaluated 116 diagnostic ureteroscopies, performed in our institution to rule out primary UTUC. Demographics, cytological findings and interpretation of preoperative imaging were obtained. Ureteroscopic diagnosis and histological results were recorded and the predictive values of diagnostic studies were determined. Follow-up data was reviewed to evaluate the oncological outcomes in patients treated endoscopically.
  
  
  RESULTS
  The pre-ureteroscopic evaluation included CTU in 91 (78%) patients. Positive and Negative predictive values of CTU were 76 and 80%, respectively. Typical filling defect on CTU was demonstrated in 38 of 89 patients. UTUC has been ruled out in 9 patients (24%) with suspicious filling defect on CTU. Endoscopic approach was implemented in 7 patients (18%). During a median follow up period of 17 months (IQR, 9-25) none of the followed patients experienced disease progression.
  
  
  CONCLUSIONS
  Nephroureterectomy was spared from 42% of patients who underwent diagnostic ureteroscopy for suspected UTUC, demonstrated on CTU. In about half of those patients tumor has been ruled out and the others were managed endoscopically. Therefore, diagnostic ureteroscopy is advised as a crucial step in confirming UTUC and treatment planning.
authors.affiliation: Institute of Urology, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shaygo1@yahoo.com.
authors.forename: Shay
authors.initials: S
authors.lastname: Golan
authors.affiliation: Institute of Urology, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. andrein2002@yahoo.com.
authors.forename: Andrei
authors.initials: A
authors.lastname: Nadu
authors.affiliation: Institute of Urology, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. davidlif@clalit.org.il.
authors.forename: David
authors.initials: D
authors.lastname: Lifshitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018666:Ureteroscopy / Q000379:methods*; D014567:Urography / Q000379:methods*; D014570:Urologic Diseases / Q000175:diagnosis*; D014571:Urologic Neoplasms / Q000175:diagnosis*