The value of an upper tract urothelial carcinoma MDT: does everyone need a diagnostic ureteroscopy
BAUS ePoster online library. Tay L. Jun 25, 2019; 259487; P12-3
Ms. Li June Tay
Ms. Li June Tay
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Abstract
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Introduction
Upper Tract Urothelial Carcinoma (UTUC) remains a challenging condition to treat due to multiple co-morbidity, radiological uncertainty, difficulty with grade/stage, false negatives, seeding concerns and treatment delays. To address this we implemented an UTUC specialist multidisciplinary team meeting (UTUCMDT) within our existing bladder cancer MDT

Methods
In addition to the bladder cancer MDT team, specialist endourologists attend this UTUCMDT. Data was prospectively recorded between January-September2018. Clinical, radiological and pathological features were analysed.

RESULTS

Of 893 cases in the bladder cancer MDT,167 cases (18.7% = 100 patients) were discussed in the UTUCMDT (mean 4.4 cases/meeting). Mean age 67 years (28-92). 48 patients with suspected malignancy underwent a diagnostic ureteroscopy/biopsy (22 benign, 26 malignant). The remaining 52 had diagnosis based on; imaging=37(15 benign, 22 malignant);previous UTUC on surveillance=4, urine tuberculosis culture=1, awaiting further investigations=9, non-urological malignancy=1. 25 patients underwent radical nephroureterectomy(RNU) with only half having a prior ureteroscopy. All RNUs confirmed malignant pathology,2 of which were non-urothelial in nature. Nephron-sparing surgery was attempted in 6 patients. 4 distal ureterectomy, 2 ureteroscopic treatment and subsequent surveillance. 13 patients were managed expectantly for their UTUC due to disease burden or performance status. 2 are undergoing chemotherapy. 3 declined surgery.

Conclusion
Despite current concern regarding the value of MDTs, introduction of a UTUCMDT has streamlined care for this complex and heterogeneous disease in particular reducing the need for ureteroscopy (24(33%) procedures saved if all had undergone ureteroscopy), reducing investigation time without compromising oncological outcomes with no evidence of benign pathology on final RNU.
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