Tumors of the renal pelvis and ureter: symptoms and diagnosis
Last reviewed: 23.04.2024
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Symptoms of tumors of the renal pelvis and ureter
Hematuria is the most common symptom of tumors in the kidney and ureter (75%). Back pain (18%) is a consequence of a violation of the outflow of urine from the bowel-pelvis system due to a tumor or as a result of urinary tract obstruction by blood clots. Complaints about dysuria are made by 6% of patients. Decreased body weight, anorexia, palpable tumor, bone pain - symptoms of tumors of the renal and ureteric pelvis, which are rare.
Diagnosis of tumors of the renal pelvis and ureter
Laboratory tests for suspected upper urinary tract tumors include general and biochemical blood tests (including creatinine, electrolytes and serum alkaline phosphatase), coagulogram, general urine analysis (confirmation of hematuria and exclusion of concomitant urinary infection).
Cytological examination of urine from the bladder is an obligatory method of investigation for suspected tumors of the upper urinary tract. Its sensitivity in highly differentiated tumors is low: the frequency of false-negative responses reaches 80%. With low-grade tumors, the sensitivity of cytological testing is much higher (83%). To increase the diagnostic efficiency of the method, selective urine sampling from both ureters is possible.
Excretory urography allows to reveal the defect of filling of the upper urinary tract, caused by a tumor, in 50-75% of observations. In 30% of patients, the tumor causes obstruction of the urinary tract, and excretory urography can reveal a non-functioning kidney.
Retrograde urography allows you to better visualize the contours of the upper urinary tract compared with excretory urography. This method is preferred in patients with severe renal failure. The diagnostic accuracy of retrograde urography in tumors of the pelvis and ureter reaches 75%.
CT (native and with intravenous bolus contrast) with a three-dimensional reconstruction of the image displaces excretory urography from the diagnostic algorithm, as it provides more complete information about the anatomical structure of the upper urinary tract and passage of urine over them. As a rule, on CT, transitional-cellular tumors are represented by the formation of an irregular form, causing a defect in filling the upper urinary tract, more often hypovascular and poorly accumulating contrast. CT has limited accuracy in the differentiation of categories Ta, T1 and T2, but is highly effective in assessing peripelvic / periureteral infiltration.
Similarly to CT, MRI plays a limited role in the diagnosis of early stages and has high accuracy in evaluating common forms of tumors of the upper urinary tract.
Cystoscopy is an obligatory method of examining patients with tumors of the upper urinary tract, aimed at detecting tumors of the bladder.
If there is a technical capability, all patients undergo ureteropyeloscopy with tumor biopsy and leaching water for cytology. The diagnostic accuracy of the method for tumors of the pelvis is 86%, the ureter - 90%. The incidence of complications of ureteropyeloscopy is 7%. Severe complications of the procedure - perforation, separation and subsequent development of ureteric stricture.
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