Computerized tomography virtual endoscopy in evaluation of upper urinary tract tumors: initial experience.

PURPOSE: To assess the usefulness of CT virtual endoscopy (VE) as an integration of CT-urography, for the detection of upper urinary tract tumor in patients with hematuria.

MATERIALS AND

METHODS

Fourteen patients with hematuria and high risk of transitional cell carcinoma of the upper urinary tract underwent urinary cytology, ultrasonography, excretory urography, cystoscopy, CT-urography with VE, and optical ureteroscopy. The CT urograms and VE were correlated with the pathological findings of surgical specimen (6/14) and cytological examination of ureteroscopy biopsy (8/14).

RESULTS

VE revealed three renal pelvic and one ureteral tumors, not producing further information did not detected at CT-urography. In two patients VE showed findings strongly indicative of malignancies, not noticed at CT-urography: ureteroscopic biopsy revealed an advanced dysplastic lesion and a malignancy, confirmed at surgery. In one patient VE was questionable (narrowing of the distal ureter) and ureteroscopic biopsy revealed an inflammation. Finally, VE diagnosed a fibrosis of the lumbar ureteral tract, confirmed at ureteroscopic biopsy. In other six patients, VE and ureteroscopy did not find abnormalities.

CONCLUSION

VE should be useful as an integration of CT-urography for a complete evaluation of the upper urinary tract in patients with suspected tumor, limiting the need for fiberoptic ureteroscopic examination.