Common presentations include:
- Haematuria
Flank pain
Systemic symptoms – weight loss, bone pain, night sweats
Incidental finding
History:
- Symptomatology – haematuria, flank pain, systemic symptoms
- Medical history and medications, fitness for anaesthesia and intervention
- Previous surgery
- CKD, renal threats, previous renal surgery
- Personal and family history of cancer (bladder cancer, Lynch syndrome)
- Smoking history and occupational exposures
Examination:
- General examination of frailty and body habitus
- Previous surgical scars
- Abdominal and genital exam
Investigations
Urine microscopy
Bloods – renal function particularly
Urine cytology – voided +/- washings
Imaging:
- CT IVP – gold standard – good sensitivity and specificity – also useful for staging (inc chest)
- Ultrasound – may show hydronephrosis or renal pelvic tumours
- RPG – typically used at time of ureteroscopy
- MRI urogram – alternate to CT if contrast allergy
- Renography – if indicated
Cystoscopy, ureteroscopy +/- biopsy +/- washings + RPG