- Design
- Retrospective two-centre diagnostic and recurrence analysis
- Population
- 133 patients with UTUC after endoscopic kidney-sparing surgery (256 ureteroscopies)
- Primary outcome
- Diagnostic accuracy of CT urography and cytology against ureteroscopy
- Effect
- Sensitivity 35.5%, NPV 48.0%; 64.5% of recurrences missed
A retrospective two-centre analysis (BJU International, 28 September 2026) studied 133 patients with upper tract urothelial carcinoma treated with endoscopic kidney-sparing surgery between 2006 and 2025, with 256 surveillance ureteroscopies each preceded by CT urography and urinary cytology within three months.
Using CT and/or cytology to trigger ureteroscopy would have avoided 69% of procedures but missed 65% of recurrences (sensitivity 35.5%, negative predictive value 48%). Cytology alone was very specific (97%) but caught only 11%; CT alone caught 27%. Recurrence rates were steady at about 0.3 events per person-year through year four, in low-risk and high-risk patients alike.
The appeal of non-invasive surveillance is obvious, especially for frail patients, but these figures show it would leave most recurrences undetected. The steady recurrence rate also argues against relaxing endoscopic follow-up over time.
- Continue scheduled ureteroscopic surveillance after kidney-sparing UTUC treatment
- Do not use a negative CT urogram or cytology to skip a planned ureteroscopy
- Keep surveillance going beyond two years - recurrence risk did not fall
- Counsel patients choosing kidney-sparing treatment that long-term endoscopy is part of the deal
Why it matters
It answers whether surveillance can safely be made less invasive: on current tools, it cannot.
Don't overread it
Retrospective data from two expert centres; newer urine biomarkers were not tested.
The statistics, in plain English
A negative predictive value of 48% means that when CT and cytology were both negative, about half of patients still had a recurrence. The steady rate of about 0.3 recurrences per person-year means roughly one every three years per patient.
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