Abstract
BackgroundWhether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT) harms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development remains controversial. This study evaluated the impact of DJ compared to nephrostomy placement during TURBT for bladder cancer (BCa) on the incidence of metachronous UUTUCs.MethodsWe retrospectively analysed 637 patients who underwent TURBT in our department between 2008 and 2016. BCa, UUTUC and urinary drainage data (retrograde/anterograde DJ and percutaneous nephrostomy) were assessed, along with the prevalence of hydronephrosis, and mortality. Chi-square and Fisher’s exact test was performed for univariate analyses. Survival analysis was performed by the Kaplan-Meier method and log-rank tests.ResultsUUTUC was noted in 28 out of 637 patients (4.4%), whereas only eight (1.3%) developed it metachronously to BCa. Out of these, four patients received DJ stents, while four patients received no urinary drainage of the upper urinary tract. Placement of urinary drainage significantly correlated with UUTUC (50.0% vs. 17.9%; p = 0.041). DJ stenting significantly correlated with UUTUC (50.0% vs. 11%; p < 0.01), while no patient with a nephrostomy tube developed UUTUC. UUTUC-free survival rates were significantly lower for patients with DJ stents than for all other patients (p = 0.001). Patients with or without DJ stents had similar overall survival (OS) rates (p = 0.73), whereas patients with nephrostomy tubes had significantly lower OS rates than all other patients (p < 0.001).ConclusionsPatients with DJ stenting during TURBT for BCa might have an increased risk of developing metachronous UUTUC. This study indicated advantages in placing nephrostomy tubes rather than DJ stents; however, confirmation requires investigation of a larger cohort. Even so, the increased mortality rate in the nephrostomy group reflected hydronephrosis as an unfavourable prognostic factor.
Highlights
Whether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT) harms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development remains controversial
This study evaluated the impact of placement of a DJ stent compared to a nephrostomy tube during TURBT for bladder cancer (BCa) on the incidence of metachronous UUTUC
DJ stenting significantly correlated with UUTUC (50.0% vs. 11%; p < 0.01)
Summary
Whether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT) harms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development remains controversial. In 17% of UUTUC patients synchronous bladder cancer (BCa) can be found [1, 2]. Only 1.8% of patients with non-muscle invasive BCa (NMIBC) show synchronous UUTUC [4], and post-cystectomy upper urinary tract recurrences occur in < 10% of BCa patients [5,6,7,8,9,10]. Risk factors for post-cystectomy UUTUC development include history of carcinoma in situ (CIS) or recurrent BCa, cystectomy for NMIBC, and tumour involvement of the distal ureter or prostatic urethra [7, 8, 10]. Risk factors for metachronous UUTUC following BCa diagnosis include high grade BCa and tumour localisation at the trigone/ureteral orifice [11, 12]
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