MP48-13 BLADDER RECURRENCE FOLLOWING DIAGNOSTIC URETEROSCOPY IN PATIENTS UNDERGOING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER: IS URETERAL ACCESS SHEATH PROTECTIVE?

Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-13 BLADDER RECURRENCE FOLLOWING DIAGNOSTIC URETEROSCOPY IN PATIENTS UNDERGOING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER: IS URETERAL ACCESS SHEATH PROTECTIVE? Antoin Douglawi, Alireza Ghoreifi, Ryan Lee, Sanam Seyedian, Jie Cai, Gus Miranda, Wenhao Yu, Gerhard Fuchs, Sumeet Bhanvadia, Anne Schuckman, Mihir Desai, Siamak Daneshmand, Monish Aron, Rene Sotelo, Inderbir Gill, and Hooman Djaladat Antoin DouglawiAntoin Douglawi More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Ryan LeeRyan Lee More articles by this author , Sanam SeyedianSanam Seyedian More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Wenhao YuWenhao Yu More articles by this author , Gerhard FuchsGerhard Fuchs More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Mihir DesaiMihir Desai More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , Monish AronMonish Aron More articles by this author , Rene SoteloRene Sotelo More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephroureterectomy (RNU) remains the gold standard for treatment of upper tract urothelial carcinoma (UTUC). Intravesical recurrence after RNU occurs relatively frequently in up to 50% of patients but the contributing factors are not well defined. We aim to examine the effect of diagnostic ureteroscopy (URS) on bladder recurrence following RNU. METHODS: Using our IRB approved UTUC database, we retrospectively reviewed the records of patients who underwent RNU between 2005-2019. Patients with a prior history of bladder cancer as well as those who did not have bladder cuff resection were excluded. Bladder recurrence was the primary outcome and cox regression model was used to assess the impact of diagnostic URS adjusting for other factors. RESULTS: Out of 271 RNU cases, 143 were included with a median age of 73 (IQR 65-80). Baseline clinicopathologic features are shown in table 1. URS was performed in 104 (73%) and a ureteral access sheath was used in 26 (25%). With a median follow-up of 27 months, the bladder recurrence rate (median time to recurrence) for patients who had URS vs. not was 31.7% (9.4 months) and 7.7% (12.1 months), respectively. A lower recurrence rate was noted in patients whom a ureteral access sheath was utilized (11.5%) vs. those with no access sheath (40.3%). High grade pathology accounted for 88% of recurrences in the URS group and 67% in the no URS group. Three patients (8.3%) had muscle invasive disease on bladder recurrence, all of which were in URS group. Multivariable analysis revealed a significant increase in bladder recurrence if a URS was performed (HR 5.7, p<0.004), however, this effect was mitigated if a ureteral access sheath was used (HR 1.3, p=0.74) [Figure 1]. The type of URS and performing a biopsy had no significant effect on bladder recurrence. CONCLUSIONS: Diagnostic ureteroscopy in patients undergoing RNU for UTUC significantly increases the risk of bladder recurrence. This effect may be mitigated by using a ureteral access sheath. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e869-e869 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antoin Douglawi More articles by this author Alireza Ghoreifi More articles by this author Ryan Lee More articles by this author Sanam Seyedian More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Wenhao Yu More articles by this author Gerhard Fuchs More articles by this author Sumeet Bhanvadia More articles by this author Anne Schuckman More articles by this author Mihir Desai More articles by this author Siamak Daneshmand More articles by this author Monish Aron More articles by this author Rene Sotelo More articles by this author Inderbir Gill More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Loading ...