Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract

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SHEN Zhou-jun(Department of Urology, Ruijin Hospital, College of Medicine,Shanghai Jiao Tong University, Shanghai 200025, China)
LI Liao-yuan(Department of Urology, First People's Hospital of Foshan, Sun Yat-sen University, Foshan 528000, Guangdong Province, China)
LIAO Guo-dong(Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China)
CHEN Dong(Department of Urology, Ruijin Hospital, College of Medicine,Shanghai Jiao Tong University, Shanghai 200025, China)
Journal Title:
Volume 120, Issue 16, 2007
Key Word:
transitional cell carcinoma; upper urinary tract; diagnosis; intravenous urography

Abstract´╝Ü Background Transitional cell carcinoma of the upper urinary tract (UUT-TCC) accounts for 5% to 10% of all renal tumours and 5% to 6% of all urothelial tumours all over the world. In China, the proportion of UUT-TCC to all urothelial tumours may be 26%, which is higher than that in the western world. The early diagnosis of UUT-TCC is difficult and the present study elucidates the diagnostic value of poor or nonvisualization (PNV) in intravenous urography in patients with UUT-TCC and its correlations with pathological findings and clinical characteristics.Methods The data of 172 consecutive patients between January 1997 and January 2005 with UUT-TCC who underwent nephroureterectomy in our departments were selected and analyzed retrospectively.Results Of our sample, 144 cases presented with gross haematuria (83.7%) and 12 with microscopic haematuria (7.0%). Forty-six cases (26.7%) were detectable by cytology. Filling defect identified 36 positive cases of 172 patients (20.9%), PNV was present in the images of 105 of 172 patients (61.0%). The detection rate by PNV (61.0%) was significantly different from that by cytology (26.7%) or by filling defect (20.9%) (P=0.031, P=0.001, respectively).Univariate logistic regression analysis for PNV showed that tumour stage, grade and size were significant predictors (P=0.028; P=0.031; P=0.006, respectively). Tumour stage and size were identified as independent risk factors in the multivariate logistic regression model (P=0.042; P=0.014).Conclusions Except for suspected urolithiasis, urinary tuberculosis or congenital abnormalities, UUT-TCC should be considered if PNV exists in intravenous urography especially of old patients. The value of PNV is much more significant than filling defect in intravenous urography in the diagnosis of UUT-TCC. It is supposed that PNV carries more risk of higher stage and larger tumour size in UTT-TCC.

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