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Organo Oficial de la Sociedad Mexicana de Urología

2023, Número 4

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Rev Mex Urol 2023; 83 (4)


El papel clínico de la ureteroscopia diagnóstica en el carcinoma urotelial del tracto urinario superior (UTUC): ¿vale la pena utilizarla?

Álvarez JC, García-Perdomo HA

Idioma: Ingles.
Referencias bibliográficas: 34
Paginas: 1-9
Archivo PDF: 166.02 Kb.


RESUMEN

El carcinoma urotelial del tracto urinario superior (UTUC) es una patología rara que representa del 5 al 10% de los carcinomas uroteliales. El diagnóstico se basa en imágenes (urografía por tomografía computarizada o urografía por resonancia magnética) y citología urinaria, con buena precisión diagnóstica. En casos dudosos, la ureteroscopia diagnóstica permite la confirmación histopatológica, una mejor estadificación e identificación de candidatos a cirugía conservadora de riñón. El objetivo fue describir el papel de la ureteroscopia diagnóstica y su relevancia clínica en pacientes con sospecha de UTUC. Presentamos una revisión no sistemática en PubMed, incluyendo fuentes adicionales por su relevancia.
En cuanto a los estudios clínicos, la urografía por TC o RMN tiene una sensibilidad y especificidad ›90% con limitación para identificar lesiones planas. La citología urinaria tiene una tasa de detección que oscila entre el 43 y el 91% entre los métodos de muestreo. Cuando se utiliza ureteroscopia diagnóstica, se utilizan diagnóstico óptico, citología selectiva y biopsia. Las herramientas más utilizadas son el ureteroscopio flexible de fibra óptica, las cestas de alambre plano y las pinzas para biopsia en copa.
La ureteroscopia podría disminuir la tasa de nefroureterectomía radical (RNU) y los diagnósticos erróneos con confirmación histopatológica. También retrasa el tiempo hasta la RNU y aumenta la recurrencia intravesical (IVR) sin comprometer los resultados oncológicos (OS, CSS, MFS, RFS). La ureteroscopia diagnóstica es una herramienta valiosa en UTUC cuando hay incertidumbre clínica.


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