Mieke Bus

2 27 Limitations and strengths of our study The fact that most of our responders are working in a university hospital (71.6%) may be considered a limitation. Our study cannot rule out the bias that diagnostic work-up is usually more extensive in a university hospital compared to non-university hospitals. Statistical anal- ysis showed that the knowledge of new techniques between urologists working in Uni- versity hospital and urologists working in a non-university hospital did not differ. A second limitation is the scarce number of questions of the survey. The survey design was deliber- ately chosen, since a concise survey is more likely to be responded. This limitation resulted in one of the strengths of our study; the high response rate of 72.3%. Conclusion Most urologists involved in the treatment of upper urinary tract tumours follow the guide- lines in their diagnostic work-up of patients suspected for UTUC. Urologists treating UTUC consider current diagnostic techniques insufficient to select suitable patients with upper tract urothelial cancer for endoscopic management. Recently, several new diagnostic tech- niques for upper urinary tract carcinoma have emerged, from which NBI and digital RIRS are best known among urologists and are considered among urologists to be most likely beneficial in the diagnostic work-up. Before successful implementation of these new diagnostics in daily routine, more methodo- logically correct research should be directed to reach reliable diagnostic accuracy and high levels of evidence. Acknowledgements The authors would like to thank all the responders of our survey for their time and effort.