After kidney-sparing UTUC treatment, keep ureteroscopic surveillance

Design

Retrospective two-centre diagnostic accuracy study

Population

133 patients, 256 surveillance ureteroscopies after endoscopic kidney-sparing UTUC treatment

Primary outcome

Accuracy of CT urography and cytology against ureteroscopy

Effect

Sensitivity 35.5%, specificity 75.0%, NPV 48.0%; 64.5% of recurrences missed

A retrospective two-centre study in BJU International (published 28 September) examined 133 patients with upper tract urothelial carcinoma treated with endoscopic kidney-sparing surgery between 2006 and 2025. Each surveillance ureteroscopy was preceded within three months by CT urography and urinary cytology, allowing a direct comparison across 256 assessments.

Using CT or cytology to trigger ureteroscopy would have avoided 69% of procedures but missed 64.5% of recurrences: sensitivity 35.5%, specificity 75.0%, negative predictive value only 48%. Cytology alone was highly specific (97%) but detected just 11% of recurrences; CT alone detected 27%. Recurrence rates stayed around 0.3 per person-year through four years in both low- and high-risk groups.

The appeal of replacing repeated ureteroscopy with imaging and urine tests is obvious. These data show that would miss most recurrences, and the steady recurrence rate means surveillance cannot be relaxed after the first year or two. Ureteroscopy remains the standard for surveillance after kidney-sparing treatment.

• Continue scheduled ureteroscopic surveillance after endoscopic kidney-sparing treatment of upper tract urothelial carcinoma.
• Do not rely on a negative CT urogram or cytology to defer surveillance ureteroscopy.
• Maintain surveillance beyond the first two years, as recurrence rates did not fall over time.
• Use CT urography to assess the contralateral tract and bladder alongside ureteroscopy.
• Counsel patients choosing kidney-sparing treatment about the long-term need for repeated ureteroscopy.

Why it matters

It closes off a tempting shortcut that would leave two-thirds of recurrences undetected.

Don't overread it

This retrospective study from two tertiary centres may not reflect every surveillance protocol or CT technique.

The statistics, in plain English

Sensitivity of 35.5% means CT or cytology flagged only about a third of recurrences seen at ureteroscopy. A negative predictive value of 48% means a negative result was right less than half the time, which is no better than a coin toss for ruling out recurrence.

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