Rationale for surveillance:
- Detect bladder tumours
- Detect local recurrence or distant metastases
- Detect recurrences in contra-lateral upper tract, or ipsilateral upper tract if following after kidney sparing surgery
EAU guidelines after nephroureterectomy
Low risk
- Cystoscopy at 3 months, then 9 months later, than annually for 5 years
- No comment on cytology or imaging
High risk
- Cystoscopy and cytology every 3 months for 2 years, then 6 monthly until 5 years, then annually
- CT IVP + CT chest every 6 months for 2 years, then annually
EAU guidelines after kidney sparing surgery
Low risk
- Ureteroscopy at 3 months
- Cystoscopy and CT IVP at 3 months, 6 months, then annually for 5 years
High risk
- Cystoscopy, cytology, CT IVP and CT chest at 3 months, 6 months, then annually.
- Ureteroscopy with washings at 3 months and 6 months.
In real life
Bespoke management per patient based on risk of recurrence, GA risks and frailty, renal function and resources available.
After neph-u:
- Cystoscopy and cytology at 3 months, then 6 monthly. CT IVP/chest at 6 months.
After endoscopic management:
- Early re-look cystoscopy/ureteroscopy/RPGs at 3 month intervals, CT IVP at 6 months, stretch out cystoscopy/ureteroscopy based on risk and recurrences