1418 FROZEN SECTION OF THE DISTAL URETER AT THE TIME OF RADICAL CYSTECTOMY: INDICATIONS BASED ON CLINICAL PREDICTIVE FACTORS

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 20121418 FROZEN SECTION OF THE DISTAL URETER AT THE TIME OF RADICAL CYSTECTOMY: INDICATIONS BASED ON CLINICAL PREDICTIVE FACTORS Oscar Rodríguez Faba, Juan Palou, Alberto Breda, Juan Antonio Peña, Lluís Gausa, Salvador Esquena, Juan Manuel López, and Humberto Villavicencio Oscar Rodríguez FabaOscar Rodríguez Faba Barcelona, Spain More articles by this author , Juan PalouJuan Palou Barcelona, Spain More articles by this author , Alberto BredaAlberto Breda Barcelona, Spain More articles by this author , Juan Antonio PeñaJuan Antonio Peña Barcelona, Spain More articles by this author , Lluís GausaLluís Gausa Barcelona, Spain More articles by this author , Salvador EsquenaSalvador Esquena Barcelona, Spain More articles by this author , Juan Manuel LópezJuan Manuel López Barcelona, Spain More articles by this author , and Humberto VillavicencioHumberto Villavicencio Barcelona, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1869AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prevalence of CIS of the distal ureter below the common iliac vessels at the time of radical cystectomy (RC) has been reported to be 2-35% in many large series, being < 1% in the ureter above the iliac vessels. It is well known that up to 17% of the patients with distal ureteral CIS at time of RC will develop a recurrence in the upper tract within 5 years from surgery. In order to reduce the risk of recurrence many are speculating on the use of frozen sections at time of RC. Despite this the role of intra-operative FS remains controversial. The objective of our study was to identify the most relevant clinical predictive factors for distal ureter CIS involvement at the time of RC to determine which patients would possibly benefit the most from intraoperative FS. METHODS We retrospectively collected clinical-pathologic data on 1114 patients who underwent RC between August 1978 and June 2002,.Patients with concomitant distal ureter CIS on final pathology were identified and compared to those with a negative ureter. Univariate and multivariate analysis (ANOVA) were performed for patient's demographics, pathology of the primary tumour (multifocality, grade, concomitant CIS, CIS in the prostatic urethra, number of recurrences prior to RC, and progression from superficial to muscle invasive tumors) and previous BCG treatments. RESULTS 61 patients (5.47%) were found to have concomitant CIS of the distal ureter at the time of RC on final pathology. Mean age was 66 (47-85), and there were 55 (90.2%) males. Median follow up was 42.5 months. On univariate analysis bladder tumor multifocality (p<0.001), high grade (p<0.001), concomitant CIS (p<0.001), prostatic urethra involvement (p<0.001), ¡Ý2 recurrences prior to RC, and BCG treatment (p< 0.001) were found to be independent predictive factors for concomitant ureteral involvement. Tumor progression prior to RC did not reach statistical significance (p=0.44). On multivariate analysis (ANOVA) only, high grade (P<0.001), concomitant CIS (p=0.004), and BCG treatment prior to RC (p<0.001) were found to be independent clinical predictive factors for CIS in the distal ureter. CONCLUSIONS High grade bladder cancer, concomitant CIS and preoperative BCG treatment were found to be independent predictors of concomitant CIS of distal ureter in our series. Therefore we believe that patients presenting with these factors may benefit the most an intraoperative frozen section with the idea of performing a wider resection in case of positive results. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e575-e576 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oscar Rodríguez Faba Barcelona, Spain More articles by this author Juan Palou Barcelona, Spain More articles by this author Alberto Breda Barcelona, Spain More articles by this author Juan Antonio Peña Barcelona, Spain More articles by this author Lluís Gausa Barcelona, Spain More articles by this author Salvador Esquena Barcelona, Spain More articles by this author Juan Manuel López Barcelona, Spain More articles by this author Humberto Villavicencio Barcelona, Spain More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...