How is cancer of the ureter or renal pelvis diagnosed?

EThe most common reasons for suspecting cancer of the ureter or renal pelvis are repeated episodes of blood in the urine, especially where cystoscopy shows no obvious cause, or finding hydronephrosis (where the kidney swells up due to a build up of urine) for which there is no obvious cause during an ultrasound examination. Repeated episodes of flank pain, generally considered to be indicative of a urinary tract stone, can also be a sign of cancer of the ureter. The upper urinary tract should also be investigated in patients with high-risk bladder cancer subtypes.

How is the disease investigated?

The best non-invasive method is a special CT scan designed to look at how a special dye (a contrast agent) passes through the urinary tract. In addition to standard images, this requires 'delayed phase' images to be captured 5–7 minutes after administering the contrast agent. This is known as a CT urogram. In the past, a procedure called an intravenous pyelogram was used. This involves taking x-rays of the kidneys after administering a contrast agent. This is no longer recommended, however, as it is not sufficiently accurate.

Where the results are unclear, or to obtain tissue samples to verify a diagnosis, an invasive technique called a ureteroscopy (endoscopy of the ureters) is performed. This procedure is performed under a general anaesthetic. If urine is unable to drain from the kidneys due to a blockage, in addition to taking tissue samples, this procedure can also be used to insert a ureteral stent.