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BackTable / Urology / Podcast / Episode #35

Diagnosis and Management of Upper Tract Urothelial Carcinoma

with Dr. Shahrokh Shariat

We talk with Dr. Shahrokh Shariat, chairman of Urology at the Medical University of Vienna, about diagnosis and management of upper tract urothelial carcinoma (UTUC) as well as differing AUA and EAU approaches to these malignancies.

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Diagnosis and Management of Upper Tract Urothelial Carcinoma with Dr. Shahrokh Shariat on the BackTable Urology Podcast)
Ep 35 Diagnosis and Management of Upper Tract Urothelial Carcinoma with Dr. Shahrokh Shariat
00:00 / 01:04

BackTable, LLC (Producer). (2022, March 23). Ep. 35 – Diagnosis and Management of Upper Tract Urothelial Carcinoma [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Shahrokh Shariat discusses Diagnosis and Management of Upper Tract Urothelial Carcinoma on the BackTable 35 Podcast

Dr. Shahrokh Shariat

Prof. Dr. Shariat heads the University Clinic for Urology at the Vienna General Hospital in Austria.

Dr. Aditya Bagrodia discusses Diagnosis and Management of Upper Tract Urothelial Carcinoma on the BackTable 35 Podcast

Dr. Aditya Bagrodia

Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.

Synopsis

In this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Shahrokh Shariat, chairman of Urology at the Medical University of Vienna, about diagnosis and management of upper tract urothelial carcinoma (UTUC) as well as differing AUA and EAU approaches to these malignancies.

First, the doctors discuss common history and physical examination findings of patients with UTUC. Hematuria is the the most common sign, followed by flank pain and hydronephrosis. 10-15% of UTUC patients will also have Lynch syndrome, which is a condition that indicates a genetic predisposition to UTUC as well as other cancers. After initial hematuria workup, imaging of the upper tract and kidney must be obtained. Dr. Shariat obtains a CT urogram and an ultrasound for patients with suspected UTUC but waits until a tumor is identified to get a chest X-ray. Indirect signs of UTUC are: filling defects, thickening of the ureter wall, and hydronephrosis.

Performing a ureteroscopy is the next step in UTUC patients. A ureteroscopy obtains adequate specimen for grading and reveals tumor behavior and location. A ureteroscopy can also be used as a therapeutic approach if kidney preservation is possible. Dr. Shariat uses a “no touch technique” in which he uses an access sheath to prevent tumor seeding. He prefers to use a flexible ureteroscope, a holmium laser, and a basket for collection. After ureteroscopy, he places a double J stent in his patients and waits for 6 weeks before taking a second look and starting alternating imaging, if needed.

Surgical intervention may be required to treat non-metastatic UTUC. Dr. Shariat usually administers four rounds of neoadjuvant chemotherapy to his patient before operating. He recommends checking the patient’s renal function to see if cisplatin-based therapy can be tolerated. Dr. Bagrodia and Dr. Shariat then compare the outcomes of cisplatin and carboplatin-based therapy.

Next, Dr. Shariat shares his tips for segmented ureterectomy. Although this procedure is relatively uncommon, he advocates for careful closure, intraoperative chemotherapy, and clipping the ureter above and below the tumor to prevent seeding.

To end the episode, the doctors discuss new UTUC therapeutic options, such as JELMYTO, a gel-based chemotherapy administered through a catheter. Finally, Dr. Shariat emphasizes once more that UTUC is a heterogenous cancer that requires multimodal therapy.

Transcript Preview

[Dr. Shahrokh Shariat]
We have a lot of rare tumors, even testicular cancer. If we think about it, it's not that common a disease. So putting all these brilliant minds together, getting the researchers active, the clinicians, young dynamic minds, pushing the agenda, learning from other specialties, learning from the endoscopies, from the stone experts. And so it has really been, and technological access has revolutionized our view of the disease, but has not changed the biology of the disease. Just helped us to address the biology better.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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