Abstract
ABSTRACTPurpose:To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU).Materials and Methods:Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified.Results:RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p <0.001). The following variables differed significantly between the IVR and non-IVR groups: age (64.6±8.51 vs. 59.6±9.65 years), tumor location (lower or upper; 53.1% vs. 20%), tumor invasiveness (> pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR.Conclusion:Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.
Highlights
Upper tract urothelial carcinoma (UTUC) accounts for 5-10% of urothelial neoplasms and 10% of renal tumors [1]
Given the limitations of retrospective single-center series, performance of retrograde pyelography (RGP) before Radical nephroureterectomy (RNU) was shown to have a negative effect on intravesical recurrence (IVR) after surgery
Characteristics of the study subjects Forty-one (56.1%) of the 72 study subjects underwent RGP to determine the presence of UTUC before RNU
Summary
Upper tract urothelial carcinoma (UTUC) accounts for 5-10% of urothelial neoplasms and 10% of renal tumors [1]. Radical nephroureterectomy (RNU) with bladder cuffing is the established ‘gold standard’ for the management of UTUC [2]. Two dominant theories have been proposed to explain the mechanism of IVR: monoclonal and oligoclonal spread. According to the former hypothesis, IVR produces abnormal cell spread to the bladder before RNU or may increase the ability of locally budding tumors to release cancer cells into the urinary tract [6]. The latter hypothesis involves carcinogenic exposure of the entire urothelial layer leading to independent multifocal tumor development within the urinary tract [7]
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