<p><strong> </strong><strong>For intermediate- or high-risk patients, clinicians should perform surveillance upper tract imaging at one to two year intervals. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>As is the case with low-risk patients, there are no studies that directly compare varying upper tract imaging surveillance regimens on oncologic outcomes in NMIBC patients. Retrospective cohort studies have suggested, however, that in a “higher-” risk cohort of patients, including those with higher-grade, multiple recurrences, or stage T1 disease, the subsequent rate of upper tract recurrence is as high as 10%<sup>74, 242</sup> of which almost half will have at least stage T1 disease. As such, these recurrences which are often high-stage and/or high-grade are potentially life threatening. Whether routine imaging in asymptomatic patients is likely to diagnose such recurrences in a manner that actually improves oncologic outcomes or therapeutic options, is controversial.<sup>323</sup> Nevertheless, the Panel believes that periodic upper tract surveillance imaging offers potential benefit in this patient population. While optimally upper tract surveillance would be through the use of CT urography, the Panel acknowledges that not all patients can undergo this study. Alternative options can include MR urography, retrograde pyelography, renal ultrasound, or foregoing upper tract imaging depending on the patient’s comorbidities and shared decision-making regarding the risks of alternative imaging approaches.</p>