UTUC

Question 1

What does UTUC stand for?

Answer 1

Upper Tract Urothelial Carcinoma

Question 2

What percentage of urothelial carcinomas are UTUCs?

Answer 2

5-10%

Question 3

Which is more common: pyelocaliceal or ureteral tumors?

Answer 3

Pyelocaliceal tumors

Question 4

Which part of the ureter is most commonly affected?

Answer 4

Distal ureter (70%)

Question 5

What is the peak incidence age for UTUC?

Answer 5

Around 60 years

Question 6

How much more common is UTUC in men?

Answer 6

3 times more common

Question 7

What syndrome is associated with UTUC?

Answer 7

Lynch syndrome

Question 8

What percentage of UTUC cases are associated with bladder cancer?

Answer 8

20-50% (metachronous)

Question 9

What is the most common histologic type of UTUC?

Answer 9

Urothelial (Transitional cell) carcinoma

Question 10

What grade classifications exist for UTUC?

Answer 10

Low grade and High grade

Question 11

What is the most common presenting symptom of UTUC?

Answer 11

Hematuria (70-80%)

Question 12

What is the gold standard for UTUC diagnosis and staging?

Answer 12

CT-IVU

Question 13

What imaging technique is used when CT is contraindicated?

Answer 13

MRI in excretory phase

Question 14

What is ureterorenoscopy used for in UTUC diagnosis?

Answer 14

Biopsies and selective urinary cytology

Question 15

What is the conservative endourological treatment for UTUC?

Answer 15

Ureterorenoscopy with laser fibers

Question 16

When is conservative treatment indicated for high-grade UTUC?

Answer 16

Imperative cases only (e.g. solitary kidney)

Question 17

What is the surgical treatment for segmental ureteral tumors?

Answer 17

Segmental ureterectomy

Question 18

What is Casati-Boari technique used for?

Answer 18

Bladder flap reconstruction of removed ureter

Question 19

What is the gold standard surgical treatment for UTUC?

Answer 19

Nephroureterectomy

Question 20

What is removed during a nephroureterectomy?

Answer 20

Kidney, renal pelvis, ureter, bladder cuff

Question 21

Why is lymphadenectomy important in UTUC?

Answer 21

Improves survival in high-grade tumors

Question 22

How can local chemo or immunotherapy be administered?

Answer 22

Via nephrostomy, ureteral or bladder catheter

Question 23

What is a bladder cuff?

Answer 23

The portion of bladder around the ureteral orifice removed in nephroureterectomy

Question 24

What is a common conservative surgery for renal tumors?

Answer 24

Polarectomy or heminephrectomy

Question 25

What tool is often used in conservative endourological treatment?

Answer 25

Holmium laser

Question 26

How is high-grade UTUC managed if kidney-sparing is not feasible?

Answer 26

Radical nephroureterectomy

Question 27

What is the recurrence rate in conservative UTUC treatment?

Answer 27

High (up to 25%)

Question 28

What follow-up is recommended after conservative UTUC treatment?

Answer 28

Cystoscopy, ureteroscopy, cytology, and CT urography

Question 29

When should cystoscopy be done after UTUC treatment?

Answer 29

After 3 months and then annually

Question 30

What follow-up is needed for radical treatment in high-grade UTUC?

Answer 30

CT and chest X-ray every 6 months for 2 years, then annually

Question 31

What imaging identifies filling defects in UTUC?

Answer 31

CT-IVU

Question 32

What percent of UTUCs are multifocal and ipsilateral?

Answer 32

27-36%

Question 33

What percent of UTUCs are bilateral?

Answer 33

2-8%

Question 34

What non-urothelial tumors may occur in the upper tract?

Answer 34

Sarcomas

Question 35

What symptom occurs in 15% of UTUC cases?

Answer 35

Flank pain

Question 36

What proportion of UTUCs are found incidentally?

Answer 36

0.05

Question 37

What imaging level is ureterorenoscopy considered?

Answer 37

Level III

Question 38

What kind of tumors are endourological treatments best for?

Answer 38

Low-grade, non-invasive tumors

Question 39

What is selective urinary cytology?

Answer 39

Cytological sampling from specific locations during URS

Question 40

What reconstruction may be used when long ureter segments are removed?

Answer 40

Bladder flap (Casati-Boari)

Question 41

What is the primary goal of local chemotherapy/immunotherapy?

Answer 41

Adequate drug contact with tumor tissue

Question 42

How long should local chemo remain in the tract?

Answer 42

1-2 hours

Question 43

What is the challenge with treating UTUC compared to bladder cancer?

Answer 43

Thinner walls and more difficult access

Question 44

Why might a prone position be used in UTUC imaging?

Answer 44

Facilitates urine accumulation for better imaging

Question 45

What is the recurrence risk after bladder cancer for UTUC?

Answer 45

2-3%

Question 46

What percentage of bladder cancer patients develop UTUC later?

Answer 46

1-20%

Question 47

Why is biopsy not always performed in UTUC?

Answer 47

Technical difficulty and sometimes unnecessary with clear imaging

Question 48

What is a hydronephrosis sign in UTUC imaging?

Answer 48

Loss of normal papilla shape

Question 49

What determines follow-up frequency after UTUC treatment?

Answer 49

Tumor aggressiveness

Question 50

When is MRI preferred over CT for UTUC?

Answer 50

In patients with contrast allergies or contraindications