Abstract
ABSTRACTPurpose:To determine the effect of diagnostic ureteroscopy on intravesical recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).Materials and Methods:We conducted a retrospective analysis of 664 patients who were treated with RNU for UTUC from June 2000 to December 2011, excluding those who had concomitant/prior bladder tumors. Of the 664 patients, 81 underwent diagnostic ureteroscopy (URS). We analyzed the impact of diagnostic ureteroscopy on intravesical recurrence (IVR) using the Kaplan-Meier method. Univariate and multivariate analyses were used to determine the independent risk factors.Results:The median follow-up time was 48 months (interquartile range (IQR): 31-77 months). Patients who underwent ureteroscopy were more likely to have a small (p<0.01), early-staged (p=0.019), multifocality (p=0.035) and ureteral tumor (p<0.001). IVR occurred in 223 patients during follow-up within a median of 17 months (IQR: 7-33). Patients without preoperative ureteroscopy have a statistically significant better 2-year (79.3%±0.02 versus 71.4%±0.02, p<0.001) and 5-year intravesical recurrence-free survival rates (64.9%±0.05 versus 44.3%±0.06, p<0.001) than patients who underwent ureteroscopy. In multivariate analysis, the diagnostic ureteroscopy (p=0.006), multiple tumors (p=0.001), tumor size <3cm (p=0.008), low-grade (p=0.022) and pN0 stage tumor (p=0.045) were independent predictors of IVR.Conclusions:Diagnostic ureteroscopy is independently associated with intravesical recurrence after radical nephroureterectomy.
Highlights
Upper tract urothelial carcinoma (UTUC) is rare and accounts for only 5-10% of urothelial carcinoma cases, with an annual incidence of 1-2 cases per 100.000 in Western countries [1,2,3]
Several risk factors are reported to be associated with intravesical recurrence (IVR), such as the age, sex, tumor location, multiplicity, size, surgical approach and distal ureter ibju | URETEROSCOPY for Upper Tract Urothelial Carcinoma AND INTRAVESICAL RECURRENCE
In the guidelines for NCCN, all UTUC patients after Radical nephroureterectomy (RNU) are recommended to undergo cystoscopy for routine bladder surveillance [12]
Summary
Upper tract urothelial carcinoma (UTUC) is rare and accounts for only 5-10% of urothelial carcinoma cases, with an annual incidence of 1-2 cases per 100.000 in Western countries [1,2,3]. Radical nephroureterectomy (RNU) with bladder cuff excision is the gold standard for managing UTUC [4]. Several risk factors are reported to be associated with IVR, such as the age, sex, tumor location, multiplicity, size, surgical approach (open or laparoscopic surgery) and distal ureter ibju | URETEROSCOPY for Upper Tract Urothelial Carcinoma AND INTRAVESICAL RECURRENCE management, T stage, grade, carcinoma in situ, and history of bladder cancer [7]. The European guidelines suggest that diagnostic ureteroscopy should be performed in the preoperative assessment of any UTUC patient (Grade C) [8]. Concerns have been raised that there is a possible risk of tumor implantation during ureteroscope manipulation and irrigation [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
