<p><strong> </strong><strong>In asymptomatic patients with a history of low-risk NMIBC, clinicians should not perform routine surveillance upper tract imaging. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>There are no studies that directly test whether differing follow-up regimens for upper tract imaging impact oncologic outcomes among NMIBC patients. However, there are several retrospective single cohort series that suggest that patients with “lower-risk” bladder cancer have a low incidence of subsequent upper tract urothelial carcinoma in the order of 0.6-0.9%.<sup>74, 242</sup> Furthermore, a more recent cohort study suggests that even among those who do develop upper tract recurrence after a diagnosis of NMIBC, only 29% are incidentally found on routine surveillance imaging.<sup>323</sup><sup> </sup>The remaining recurrences were found only after the patient developed symptoms prompting an evaluation. Optimal upper tract imaging currently utilizes CT with the administration of intravenous contrast. Therefore, the Panel felt that in asymptomatic, low-risk patients, routine use of upper tract imaging for surveillance unnecessarily subjects patients to the risks associated with intravenous contrast reagents, including nephrotoxicity, anaphylaxis, and repeated radiation exposure with only a small chance of detecting upper tract urothelial carcinoma.</p>