Positive ureteric margins at radical cystectomy: Can it be predicted at initial transurethral resection of bladder tumour?

To identify primary tumour-related factors at transurethral resection of bladder tumour (TURBT) that may predict positive distal ureteric margins (PUM) at the time of radical cystectomy (RC).

A retrospective, cohort study was conducted using our institution's data from June 2007 to June 2016. Patients who underwent TURBT followed by RC for non-metastatic urothelial carcinoma (UC) of the bladder were identified. In all, 211 patients underwent RC for UC during the study period. The patients were divided into two groups: Group-I (n = 17) with PUM and Group-II (n = 194) with negative ureteric margins. Univariate and multivariate analyses were performed to determine the predictors of PUM.

On univariate analysis, multifocality, tumours involving the ureteric orifice, trigonal tumours, presence of carcinoma in situ (CIS), and lymphovascular invasion at TURBT, were significantly more common in Group-I. On multivariate analysis, tumour involvement in the ureteric orifice(s) and presence of associated CIS significantly predicted PUM.

Primary tumour-related factors on initial TURBT that predicted PUM (at RC) were involvement of the ureteric orifice(s) and presence of associated CIS. These results may help to select patients who can be selectively offered intraoperative frozen section analysis.

Arab journal of urology. 2018 Jul 14*** epublish ***

Onkar Singh, Thampi John Nirmal, Rajiv Paul Mukha, Gowri Mahasampath, J Chandrasingh, Antony Devasia, Santosh Kumar, Nitin Sudhakar Kekre

Department of Urology, Christian Medical College and Hospital, Vellore, Tamilnadu, India., Department of Biostatistics, Christian Medical College, Vellore, Tamilnadu, India.