Oncologic Monitoring After Radical Nephroureterectomy

Tumor recurrence after radical nephroureterectomy (RNU) for upper tract urothelial cell carcinoma (UTUCC) can occur in the bladder, the contralateral upper urinary tract, or systemically. Therefore, oncologic monitoring after RNU requires a multimodal approach that accounts for the various sites and patterns of recurrence. In this chapter, we describe the different rates of recurrence, associated factors, and recommendations for oncologic monitoring for post-RNU recurrence by site of tumor relapse (intravesical, contralateral upper urinary tract, and systemic) and by risk category as defined by NCCN stages (low-risk: stage 0 or 1; high-risk: stage ≥2 or positive lymph nodes) (Fig. 38.1).