Resection of the Intramural Portion of the Distal Ureter During Transurethral Resection of Bladder Tumors: Predictive Factors for Secondary Stenosis and Development of Upper Urinary Tract Recurrence

PURPOSE - We analyzed the incidence and predictive factors for development of ureteral stenosis and upper urinary tract urothelial carcinoma (UTUC) recurrences after resection of tumors located in the intramural portion of the distal ureter (IMPDU).

MATERIALS AND METHODS - We performed a retrospective analysis of 2317 patients who underwent transurethral resection of bladder tumors (TURBT) for non-muscle-invasive bladder cancer (NMIBC). We reviewed the records of 112 (4. 83%) patients treated with tumors involving the IMPDU. Multivariate cox regression analysis was used to determine predictive factors for ureteral stenosis and UTUC recurrence.

RESULTS - At a mean follow-up of 56 months, 17(15. 2%) patients had presented UTUC recurrences and 13(11. 6%) developed ureteral stenosis. In univariate analysis previous recurrences were associated with both events. In multivariate analysis tumor size ≥1. 5 cm. (HR=4. 521, p=0. 023) and T1 tumor stage (HR=8. 525, p=0. 005) were independent predictive factors for development of stenosis. Moreover T1 stage in the bladder (HR=7. 253, p=0. 001) and presence of CIS in the IMPDU (HR=6. 850, p=0. 005) increased the risk of UTUC recurrence. The lack of information about vesicoureteral reflux due to the retrospective design is the main limitation.

CONCLUSIONS - Involvement of the IMPDU is an uncommon event. In patients with NMIBC and involvement of the IMPDU, T1 tumor stage and tumor size ≥1. 5 cm are independent predictive factors for development of distal ureteral stenosis. Moreover T1 stage and CIS in the IMPDU significantly increase the risk of UTUC recurrence. Closer follow-up of the urinary tract should be undertaken in this subgroup of patients.

The Journal of urology. 2016 Jan 20 [Epub ahead of print]

O Rodriguez Faba, J M Gaya, Alberto Breda, Pablo Juarez Del Dago, Francesca Pisano, Daniel Salas, Joan Palou

Department of Urology, Fundació Puigvert, Barcelona, Spain. Department of Urology, Fundació Puigvert, Barcelona, Spain. , Department of Urology, Fundació Puigvert, Barcelona, Spain. , Department of Urology, Fundació Puigvert, Barcelona, Spain. , Department of Urology, Fundació Puigvert, Barcelona, Spain. , Department of Urology, Fundació Puigvert, Barcelona, Spain. , Department of Urology, Fundació Puigvert, Barcelona, Spain.

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