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Renal pelvis and ureter tumors - Symptoms and diagnosis
Last reviewed: 04.07.2025
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Symptoms of tumors of the renal pelvis and ureter
Hematuria is the most common symptom of renal pelvis and ureter tumors (75%). Back pain (18%) is a consequence of impaired urine outflow from the renal pelvis due to a tumor or due to obstruction of the urinary tract by blood clots. Dysuria is reported by 6% of patients. Weight loss, anorexia, palpable tumor, bone pain are symptoms of renal pelvis and ureter tumors that are rare.
Diagnostics of tumors of the renal pelvis and ureter
Laboratory tests performed when an upper urinary tract tumor is suspected include complete blood count and biochemistry (including creatinine, electrolytes, and serum alkaline phosphatase), a coagulogram, and a general urine analysis (to confirm hematuria and exclude concomitant urinary infection).
Cytological examination of urine from the bladder is a mandatory method of examination when tumors of the upper urinary tract are suspected. Its sensitivity for highly differentiated tumors is low: the frequency of false negative responses reaches 80%. For poorly differentiated tumors, the sensitivity of cytological examination is much higher (83%). Selective collection of urine from both ureters allows increasing the diagnostic efficiency of the method.
Excretory urography can detect a filling defect in the upper urinary tract caused by a tumor in 50-75% of cases. In 30% of patients, the tumor causes urinary tract obstruction, and excretory urography can detect a non-functioning kidney.
Retrograde urography allows better visualization of the contours of the upper urinary tract compared to excretory urography. This method is preferable in patients with severe renal failure. The diagnostic accuracy of retrograde urography for tumors of the renal pelvis and ureter reaches 75%.
CT (native and with intravenous bolus contrast) with three-dimensional image reconstruction displaces excretory urography from the diagnostic algorithm, as it provides more complete information about the anatomical structure of the upper urinary tract and the passage of urine through them. As a rule, transitional cell tumors are represented on CT by an irregularly shaped formation that causes a filling defect in the upper urinary tract, often hypovascular and poorly accumulating contrast. CT has limited accuracy in differentiating Ta, T1 and T2 categories, but is highly effective in assessing peripelvic/periureteral infiltration.
Similar to CT, MRI has a limited role in diagnosing early stages and is highly accurate in assessing advanced forms of upper urinary tract tumors.
Cystoscopy is a mandatory method of examination of patients with tumors of the upper urinary tract, aimed at identifying tumors of the bladder.
If technically possible, all patients undergo ureteropyeloscopy with tumor biopsy and collection of lavage fluid for cytological examination. The diagnostic accuracy of the method for tumors of the renal pelvis is 86%, and for ureters - 90%. The incidence of complications of ureteropyeloscopy is 7%. Severe complications of the procedure include perforation, rupture, and subsequent development of ureteral stricture.
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