The bladder cuff management and its surgical approach represent an essential and debated step in radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The objective of our study was to determine which bladder-cuff management has the best oncological outcomes in terms of bladder recurrence-free survival ( BRFS).

We retrospectively analyzed all patients who underwent an open robot-assisted laparoscopic (RNU) or a combined RNU between March 2012 and March 2019 in three academic hospitals. Bladder-cuff management approaches were divided into two categories: (O-cuff) open bladder cuff and (R-cuff) robot-assisted bladder cuff. We assessed demographic characteristics, distal ureter approach, pathology, and operative details as well as oncological outcomes including BRFS. Survival was analysed using the Kaplan-Meier method and compared using the log-rank test. A multivariable analysis was performed to identify predictive factors of bladder recurrence.

A total of 117 patients were included with a mean follow-up of 40.4 months. Patients with a history of bladder cancer, RNU with pure laparoscopic approach and endoscopic bladder cuff were excluded. There were 53 (45%) patients in the O-cuff group and 64 (55%) in the R-cuff group. BRFS at 2 years was 73.3% and 72.7% for O-cuff and R-cuff respectively (p=0.9). On multivariable analysis, distal ureter tumor (odds ratio (OR): 6.24, 95% CI: 1.95- 21.5; p < 0.01) was associated with bladder recurrence (BR).

There was no statistically significant difference in BRFS between the O-cuff and R-cuff groups. Nevertheless, we underlined that distal ureter tumor was associated with bladder recurrence. Although we did not find differences regarding the surgical approach, bladder-cuff remains a very important step of RNU and caution should be taken when performed laparoscopically to avoid any tumor spillage. Risk factors for bladder cancer recurrence might be taken into account for the choice of its surgical approach. .

Journal of endourology. 2021 Jun 13 [Epub ahead of print]

Marina Pizzighella, Franck Bruyere, Benoit Peyronnet, Vivien Grafeille, Nicolas Brichart, Keiichiro Mori, Gregory Verhoest, Karim Bensalah, Marco Moschini, Evenguelos Xylinas, Benjamin Pradere

Hopital Bretonneau, 26927, 2 boulevard Tonnelé, Tours, France, 37044; ., CHRU Tours, 26928, urology, 2 bd Tonnellé, Tours, France, 37044; ., CHU Rennes, Department of urology, 2 rue Henri Le Guilloux, Rennes, France, 35000; ., CHU Rennes, 36684, Department of urology, Rennes, Bretagne, France; ., CHR Orleans, 52817, Department of urology, Orleans, Centre, France; ., The Jikei University School of Medicine, Urology, Minato, Tokyo, Japan; ., RENNES Univeristy Hospital, Urology, Henri Le Guillou St, RENNES, France, 35033; ., Rennes University Hospital (France), Urology, 2 rue Henri Le Guillou, Rennes, France, 35000; ., Luzerner Kantonsspital, 30748, Luzerner Kantonsspital, Luzern, Switzerland, 6000., APHP, 26930, Department of urology, Paris, Île-de-France, France; ., CHU Tours, Department of urology, Tours, France.