title: Is Ureteroscopy Needed Prior to Nephroureterectomy? An Evidence-Based Algorithmic Approach.
abstract: OBJECTIVE
  To develop an evidence-based approach to the diagnostic workup of suspicious upper urinary tract lesions.
  
  
  METHODS
  The PubMed database was searched using the following terms with a filter for English language: "upper tract urothelial carcinoma" and "upper tract transitional cell carcinoma," along with the following corresponding terms: "cost," "epidemiology," "diagnosis," "ureteroscopy," and "workup." A total of 404 articles were returned, and 33 were reviewed in full based on relevance.
  
  
  RESULTS
  Computed tomography urogram is both sensitive and specific (96% and 99%). Cytology is utilized for its specificity (89%-100%). Ureteroscopy and biopsy of an upper tract lesion can be helpful in equivocal cases but can pose challenges in terms of yield and eventual pathologic upstaging. Due to the high sensitivity and specificity of other noninvasive tests, ureteroscopy can be obviated in select cases. We assess the available evidence and devise an algorithm for the evaluation of an upper tract urothelial carcinoma lesion.
  
  
  CONCLUSIONS
  Ureteroscopy can be omitted as part of the diagnostic workup in appropriately selected cases of upper tract urothelial carcinoma.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Potretzke
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: B Alexander
authors.initials: BA
authors.lastname: Knight
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Theodora A
authors.initials: TA
authors.lastname: Potretzke
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Larson
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: bhayani@wustl.edu.
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
mesh_terms: D000465:Algorithms; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D019317:Evidence-Based Medicine; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D018666:Ureteroscopy