BackTable Urology Ep. 143 Navigating Upper Tract Urothelial Carcinoma with Dr. Padraic O'Malley
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Dec 20, 2023 Dr. Padraic O'Malley, a urologic oncologist from the University of Florida Health, dives deep into upper tract urothelial carcinoma diagnosis and treatment. He discusses innovative approaches like tumor ablation and the role of neoadjuvant chemotherapy. The conversation touches on the significance of Lynch syndrome, updated staging guidelines, and the use of the Thulium laser. Dr. O'Malley emphasizes the need for risk stratification and standardized reporting to enhance patient management and improve treatment outcomes.
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Cystoscopy for Upper Tract Cancer
- Always perform cystoscopy in patients with upper tract urothelial carcinoma, regardless of prior ureteroscopy.
- This helps understand bladder status and avoids surprises during treatment.
Improving Urine Cytology
- Urine cytology yields improve with selective ureteric washing compared to voided samples.
- Barbotage with a 5-French open-ended catheter during washing further enhances the yield.
Biopsy and Recurrence Risk
- Biopsying upper tract urothelial carcinoma before nephroureterectomy may increase bladder recurrence risk.
- Consider foregoing biopsies if the diagnosis is clinically evident and management won't change.