Computerized tomography virtual endoscopy in evaluation of upper urinary tract tumors: initial experience

Purpose  To assess the usefulness of CT virtual endoscopy (VE) as an integration of CT-urography, for the detection of upper urinary tract tumor in patients with hematuria. Materials and methods  Fourteen patients with hematuria and high risk of transitional cell carcinoma of the upper urinary tract underwent urinary cytology, ultrasonography, excretory urography, cystoscopy, CT-urography with VE, and optical ureteroscopy. The CT urograms and VE were correlated with the pathological findings of surgical specimen (6/14) and cytological examination of ureteroscopy biopsy (8/14). Results  VE revealed three renal pelvic and one ureteral tumors, not producing further information did not detected at CT-urography. In two patients VE showed findings strongly indicative of malignancies, not noticed at CT-urography: ureteroscopic biopsy revealed an advanced dysplastic lesion and a malignancy, confirmed at surgery. In one patient VE was questionable (narrowing of the distal ureter) and ureteroscopic biopsy revealed an inflammation. Finally, VE diagnosed a fibrosis of the lumbar ureteral tract, confirmed at ureteroscopic biopsy. In other six patients, VE and ureteroscopy did not find abnormalities. Conclusion  VE should be useful as an integration of CT-urography for a complete evaluation of the upper urinary tract in patients with suspected tumor, limiting the need for fiberoptic ureteroscopic examination. Contributions: G. Battista and R. Schiavina designed the study. G. Battista and C. Sassi wrote the article. C. Sassi, E. Baglivo, and R. Schiavina compared the result on VE with clinical and imaging examinations and contributed to paper writing. A. Franceschelli was responsible for the clinical and surgery data reported in the article. G. Martorana and R. Canini are the heads of the Urology and Radiology Department, respectively; they critically revised the different versions of the article before editing.