CT urography and cytology cannot replace ureteroscopy after kidney-sparing UTUC surgery

Design

Retrospective two-centre diagnostic accuracy study, 2006–2025

Population

133 patients with endoscopically managed UTUC; 256 surveillance ureteroscopies

Primary outcome

Accuracy of CT urography and cytology against ureteroscopy

Effect

Sensitivity 35.5%, specificity 75.0%; 64.5% of recurrences missed (56.0–72.4)

This retrospective two-centre study, published in BJU International on 28 September, examined 133 patients whose upper tract urothelial carcinoma was treated endoscopically between 2006 and 2025. It compared CT urography and urine cytology done within three months before 256 surveillance ureteroscopies against what the ureteroscopy found.

Combined CT and/or cytology had sensitivity 35.5% and specificity 75.0%. Using them to decide who needed ureteroscopy would have avoided 69% of procedures but missed 64.5% of recurrences. Cytology alone was 97% specific but only 11% sensitive; CT alone was 27% sensitive. Recurrence ran at about 0.3 per person-year through four years in both low- and high-risk groups.

The appeal of replacing repeated ureteroscopies with scans is obvious. These data show it would miss most recurrences, and that recurrence risk does not fall over time. Endoscopic surveillance should continue long term, with imaging and cytology as additions rather than substitutes.

• Keep scheduled ureteroscopic surveillance after kidney-sparing surgery for UTUC.
• Do not use a negative CT urogram or cytology to skip a planned ureteroscopy.
• Continue surveillance beyond the early years; recurrence rates did not fall.
• Treat a positive cytology as a strong prompt for early ureteroscopy.
• Explain the long-term surveillance commitment before choosing kidney-sparing treatment.

Why it matters

Swapping scopes for scans would have missed about two in three recurrences.

Don't overread it

A retrospective two-centre series with modest numbers.

The statistics, in plain English

Sensitivity of 35.5% means the non-invasive tests flagged only about one in three recurrences that ureteroscopy found. A negative predictive value of 48% means a negative scan and cytology left close to even odds of recurrence.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.