691 LIMITED SIGNIFICANCE OF ROUTINE EXCRETORY UROGRAPHY AS A SURVEILLANCE OF THE UPPER URINARY TRACT IN FOLLOW-UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER AFTER TRANSURETHRAL RESECTION

Abstract

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013691 LIMITED SIGNIFICANCE OF ROUTINE EXCRETORY UROGRAPHY AS A SURVEILLANCE OF THE UPPER URINARY TRACT IN FOLLOW-UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER AFTER TRANSURETHRAL RESECTION Hideaki Miyake, Ken-ichi Harada, and Masato Fujisawa Hideaki MiyakeHideaki Miyake Kobe, Japan More articles by this author , Ken-ichi HaradaKen-ichi Harada Kobe, Japan More articles by this author , and Masato FujisawaMasato Fujisawa Kobe, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.247AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The primary objective of upper tract surveillance after transurethral resection (TUR) of non-muscle invasive bladder cancer is to identify upper urinary tract cancers (UUTCs) at an early stage in asymptomatic patients, so that curative treatment can be offered. However, because of the lack of definitive guideline, there are several controversies associated with the surveillance of UUTC, including patient selection, type of imaging study and its frequency. The objective of this study was to evaluate the utility of routine excretory urography (IVP) for detecting subsequent UUTC during follow-up of patients with non-muscle invasive bladder cancer. METHODS This study included 613 patients who underwent TUR of non-muscle invasive bladder cancer between January 1990 and December 2010, and followed for at least 1 year. After TUR, patients were followed by periodic cystoscopy, urinary cytology and IVP. The risk factors for upper urinary tract recurrence following TUR were analyzed, and based on this outcome, we then determined whether routine IVP should be performed for patients with non-muscle invasive bladder cancer. RESULTS During the observation period, UUTCs developed in 30 of the 613 patients (4.9%) with the median interval of 34 months from initial TUR to the detection of UUTCs. Among several factors examined, only multiplicity was significantly associated with upper urinary tract recurrence after TUR. Of the 30 patients with secondary UUTCs, only 3, who had multiple non-muscle invasive bladder cancers at initial presentation, were diagnosed as having UUTCs by routine IVP, while the remaining 27 presented some symptoms suggesting possible upper tract recurrence before IVP, including macrohematuria, intravesical recurrence, positive urinary cytology, abdominal pain and high fever in 15, 8, 7, 5 and 3, respectively. CONCLUSIONS The majority of patients with recurrent UUTCs presented with some subjective and/or objective symptoms, and routine IVP failed to detect recurrent diseases in such patients. Therefore, considering the low incidence of recurrent UUTCs and the expense for upper urinary tract surveillance, it may be suitable to perform routine IVP only for patients with risk factors, such as multiple tumors at an initial TUR, associated with the development of secondary UUTCs rather than for all patients who have undergone TUR for non-muscle invasive bladder cancer. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e283-e284 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hideaki Miyake Kobe, Japan More articles by this author Ken-ichi Harada Kobe, Japan More articles by this author Masato Fujisawa Kobe, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...