Endoluminal ultrasound (ELUS) and optical coherence tomography (OCT) are advanced imaging modalities with potential for enhancing the evaluation of upper urinary tract pathologies. While widely used in other fields, their role in urology, particularly for ureteric diseases, remains underexplored. This narrative review aims to explore the current evidence for the use of ELUS and OCT in upper urinary tract pathology.

A systematic literature search was conducted to identify relevant articles from January 1990 to June 2023 using databases like MEDLINE, CINAHL, and Google Scholar. Articles discussing ELUS and/or OCT in upper urinary tract pathology were included in the review.

ELUS provides 360° imaging to a depth of 20 mm, demonstrating utility in detecting submucosal stones, evaluating stricture length and fibrosis, and avoiding crossing vessels during PUJO procedures. OCT offers superior resolution (0.01–0.015 mm) but limited penetration (2–3 mm), excelling in differentiating urothelial layers and small tumor staging. ELUS and OCT demonstrate potential in various upper urinary tract pathologies, including staging of upper tract urothelial carcinoma (UTUC), detection of bladder tumors, assessment of pelvic-ureteric junction obstruction (PUJO), localization of urolithiasis, and evaluation of ureteric strictures. Studies highlight their utility in providing real-time, intra-operative guidance and enhancing diagnostic accuracy.

ELUS and OCT offer complementary strengths, with ELUS excelling in depth penetration and OCT in high-resolution imaging. These technologies have significant potential to improve diagnostic accuracy in upper urinary tract pathologies, particularly for UTUC staging and PUJO evaluation. While promising, their integration into routine practice requires further large-scale studies to establish clinical benefit, cost-effectiveness, and training frameworks.