MP56-12 UPPER TRACT RECURRENCE RISK BASED ON DRAINAGE METHOD FOR URETERAL OBSTRUCTION PRIOR TO RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyCME1 May 2022MP56-12 UPPER TRACT RECURRENCE RISK BASED ON DRAINAGE METHOD FOR URETERAL OBSTRUCTION PRIOR TO RADICAL CYSTECTOMY Wesley Yip, Daniel Sjoberg, Nathan Wong, Manuel de Jesus Escano, Song Jiang, Carissa Chu, Nicole Benfante, Sherri Donat, Harry Herr, Guido Dalbagni, Bernard Bochner, and Eugene Cha Wesley YipWesley Yip More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Nathan WongNathan Wong More articles by this author , Manuel de Jesus EscanoManuel de Jesus Escano More articles by this author , Song JiangSong Jiang More articles by this author , Carissa ChuCarissa Chu More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Sherri DonatSherri Donat More articles by this author , Harry HerrHarry Herr More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Bernard BochnerBernard Bochner More articles by this author , and Eugene ChaEugene Cha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002639.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral obstruction by bladder tumors can cause hydronephrosis with the potential for renal dysfunction. Renal drainage can be achieved by either ureteral stent placement or percutaneous nephrostomy tube, but there is a potential risk for upper tract seeding by retrograde manipulation during stent placement and reflux of urine. We aim to determine if retrograde ureteral stent placement prior to radical cystectomy (RC) increases the risk of upper tract recurrence. METHODS: 2475 patients who underwent RC at our institution from January 2000 to June 2016 were included in our analysis. Patients were categorized by: no drainage, nephrostomy tube only, or stent with or without nephrostomy tube. Fine-Gray competing risks regression analysis was used to assess whether ureteral stent placement increased the risk of upper tract recurrence, with recurrence to another region and death from other causes as the competing events. Univariable and multivariable models were then created, with the latter adjusted for pathologic T stage, carcinoma in situ (CIS) in the RC specimen, and prior intravesical therapy. RESULTS: Of 2475 patients who underwent RC, 111 upper tract recurrences were observed with a median follow-up of 6.0 years (IQR 2.5, 9.3) among those without an event. 2203 (89%) patients had no drainage, 88 (3.6%) had a nephrostomy tube only, and 184 (7.4%) had a ureteral stent with or without nephrostomy tube. There were 98 upper tract recurrences in the no drainage group, only 1 in the nephrostomy tube group, and 12 in the ureteral stent group. The probability of upper tract recurrence based on drainage method is displayed in Figure 1. On multivariable analysis, ureteral stent placement was associated with an increased risk of upper tract recurrence (HR 2.32; 95% CI 1.27, 4.22). CONCLUSIONS: Ureteral stent placement for ureteral obstruction prior to radical cystectomy is associated with an increased risk of upper tract recurrence compared to nephrostomy tube placement, although patient selection factors not accounted for in our analyses may be present. This should be considered when weighing the risks and benefits of ureteral stent versus nephrostomy tube placement in these patients. Source of Funding: Ruth L. Kirschstein National Research Service Award T32CA082088 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e977 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Yip More articles by this author Daniel Sjoberg More articles by this author Nathan Wong More articles by this author Manuel de Jesus Escano More articles by this author Song Jiang More articles by this author Carissa Chu More articles by this author Nicole Benfante More articles by this author Sherri Donat More articles by this author Harry Herr More articles by this author Guido Dalbagni More articles by this author Bernard Bochner More articles by this author Eugene Cha More articles by this author Expand All Advertisement PDF DownloadLoading ...