The Diagnostic Ureterorenoscopy Was Associated with the Poor Intravesical Recurrence-Free Survival Following Radical Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinoma - Beyond the Abstract

A retrospective analysis of 354 patients, who underwent radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) from 10 urology centers between 2005 and 2019, was performed to evaluate the effect of diagnostic ureterorenoscopy (URS) prior to RNU on intravesical recurrence (IVR) in patients with primary UTUC.


Patients were divided into URS prior to RNU (Group 1) and no URS prior to RNU (Group 2). In Group 1, a tumor biopsy and histopathological confirmation during URS were performed in 61.1%. After a mean follow-up of 39.2 (range 12-250) months, IVR rate was 38.9% in Group 1 vs. 17.2% in Group 2 (p = 0.001). In Group 1, IVR rate was 43.1% in those undergoing intraoperative biopsy vs. 32.4% of patients without biopsy during diagnostic URS (p =0.29).

Intravesical recurrence-free survival (IRFS) was longer in Group 2 compared to Group 1 (median IRFS was 111 vs. 60 months in Groups 2 and 1, respectively (p< 0.001)). Univariate analysis revealed that IRFS was significantly associated with URS prior to RNU (HR: 2.9, 95% CI 1.65-5.41; p < 0.001). In multivariate analysis, URS prior to RNU (HR: 3.5, 95% CI 1.74-7.16; p < 0.001) was found to be an independent prognostic factor for IRFS.

This study had several limitations of note in addition to its retrospective design: (1) multi surgeons were involved in the study (2) was no definitive standard criteria for performing URS prior to RNU

Based on the results of this study, the diagnostic URS is associated with the poor IRFS following RNU for primary UTUC and its use should be limited to patients where additional information will affect treatment decisions. Intravesical chemotherapy following URS may prevent intravesical recurrence however randomized control trials are needed to assess the effects of post-URS intravesical chemotherapy on intravesical recurrence. 

Written by: Volkan İzol, Mutlu Deger, Ender Ozden, Deniz Bolat, Burak Argun, Sumer Baltaci, Orcun Celik, Hacı Murat Akgul, İlker Tinay and Yildirim Bayazit, Bladder Cancer Study Group of Association of Urooncology, Turkey

Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey., Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey, ., Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey., Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey., Department of Urology, Acibadem University, Istanbul, Turkey., Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey., Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey., Department of Urology, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey., Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.

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