Bladder cancer patients presenting with hydronephrosis may require drainage of the affected kidney before receiving further cancer treatment. Drainage can be done by retrograde stenting or percutaneously.
Retrograde stenting, however, bears the risk of tumour cell spillage to the upper urinary tract. The aim of this study was to evaluate whether bladder cancer patients are at higher risk of upper urinary tract recurrence if retrograde stenting has been performed prior to radical cystectomy.
Retrospective analysis of 1005 consecutive bladder cancer patients who underwent radical cystectomy at our department between 01/2000 and 06/2016. Negative ureteral margins intraoperatively were mandatory. Patients had regular follow-up according to our institutional protocol, including imaging of the upper urinary tract and urine cytology.
114/1005 patients (11%) had preoperative drainage of the upper urinary tract, 53/114 (46%) by double J stent and 61/114 (54%) by percutaneous nephrostomy. Among all patients, 31/1005 (3%) developed UUT recurrence after a median time from cystectomy of 17 months: 7/53 (13%) in the 'double J' group, 0% in the 'nephrostomy' group, and 24/891 (3%) in the 'no drainage' group. Multivariate regression analysis revealed a higher risk for upper urinary tract recurrence if patients had double J stenting HR 4.54 [95%CI: 1.43-14.38, p=0.01]) and and preoperative intravesical instillations (HR 2.94 [95%CI: 1.40-6.16, p=0.004]).
Patients undergoing double J stenting prior to radical cystectomy are at higher risk of upper urinary tract recurrence. If preoperative upper urinary tract drainage is required, percutaneous drainage might be recommended.
The Journal of urology. 2017 Jun 08 [Epub ahead of print]
Bernhard Kiss, Marc A Furrer, Patrick Y Wuethrich, Fiona C Burkhard, George N Thalmann, Beat Roth
Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland. Electronic address: ., Department of Urology, University Hospital of Bern, University of Bern, Bern, Switzerland., Department of Anaesthesiology and Pain Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland.
Included In: Badrinath Konety, MD 2018 AUA Presentation: Journal of Urology: Top Papers in Bladder and Renal Cancer