Nison L, Bozzini G, Rouprêt M, Traxer O, Colin P
Service d'urologie, hôpital Claude-Huriez, université de Lille, CHRU Lille, 59000 Lille, France.
Service d'urologie, hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, 83, boulevard Hôpital, AP-HP, 75013 Paris, France.
Prog Urol. 2014 Nov;24(15):977-86. doi: 10.1016/j.purol.2014.07.012. Epub 2014 Sep 8.
To propose a state-of-the art of current knowledge about clinical, ureteroscopic and photodynamic for the diagnosis of the upper urinary tract cancer (UTUC).
A systematic review of the literature search was performed from the database Medline (NLM, Pubmed), focused on the following keywords: urothelial carcinomas; upper urinary tract; ureter; renal pelvis; diagnosis; fluorescence; ureteroscopy; photodynamic technique; biopsy; cytology.
Gross hematuria and flank pain are the two main clinical symptoms revealing a UTUC in daily clinical practice. Urinary cystoscopy and cystoscopy are mandatory to rule out a concomittant synchronous bladder tumour. Flexible ureteroscopy has revolutionized the management of UTUC by allowing a full exploration of upper urinary tract, an endoscopi vizualization of the tumour and assessment of grade with biopsies. A flexible ureteroscopy is mandatory in diagnostic evaluation of UTUC as soon as a conservative management is being considered. New investigation technologies such as fluorescence, narrow band imaging and optical coherence tomography (± combined with ultra sound), are promising for a near future.
It has to be understood that the diagnostic work-up of a UTUC has to be exhaustive and particularly the search of another urothelial carcinoma within the urinary tract. Flexible ureterosocopy has revolutionized the diagnosis and management of UTUC and belongs fully to its initial evaluation.
介绍目前关于上尿路尿路上皮癌（UTUC）临床、输尿管镜及光动力诊断的最新知识。
对来自Medline（美国国立医学图书馆，PubMed）数据库的文献进行系统回顾，重点关注以下关键词：尿路上皮癌；上尿路；输尿管；肾盂；诊断；荧光；输尿管镜检查；光动力技术；活检；细胞学检查。
肉眼血尿和胁腹疼痛是日常临床实践中提示UTUC的两个主要临床症状。必须进行膀胱镜检查和尿道膀胱镜检查以排除同时存在的同步膀胱肿瘤。可弯曲输尿管镜通过对上尿路进行全面探查、对肿瘤进行内镜可视化以及通过活检评估分级，彻底改变了UTUC的治疗方式。一旦考虑采取保守治疗，在UTUC的诊断评估中必须进行可弯曲输尿管镜检查。诸如荧光、窄带成像和光学相干断层扫描（±与超声联合）等新的检查技术在不久的将来很有前景。
必须明白，对UTUC的诊断检查必须详尽，尤其是要在尿路内寻找其他尿路上皮癌。可弯曲输尿管镜彻底改变了UTUC的诊断和治疗方式，并且完全属于其初步评估的范畴。
