<p><strong> </strong><strong>Clinicians should perform upper urinary tract imaging as a component of the initial evaluation of a patient with bladder cancer. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>In patients with a known history of bladder cancer, upper tract tumors occur in less than 5% of patients and can be evaluated with common imaging techniques, including retrograde pyelography, CT, MRI, as well as transabdominal ultrasonography (US), in select cases. CT urogram or magnetic resonance (MR) urogram have advantages over US, showing not only potential hydronephrosis, but also filling defects, as well as regional lymph nodes and adjacent organs. US and retrograde pyelography are typically reserved for patients with renal function non-supportive of contrast-enhanced CT or MRI. The overall incidence of significant findings with imaging of the upper tracts in patients with newly diagnosed bladder cancer is low but increases with tumors of the trigone, CIS, and high-risk disease.<sup>73, 74</sup> The timing of initial upper tract imaging for bladder cancer is not clear, but it should likely be risk stratified and generally within six months of initial diagnosis. Repeat upper tract imaging should occur every one to two years in high-risk patients.</p>