Background: To improve the selection of patients for ureteroscopy, avoid excessive testing and reduce costs, we aimed to develop and validate a diagnostic urine assay for upper tract urinary carcinoma (UTUC). Methods: In this cohort study we recruited 402 patients from six Hunan hospitals who underwent ureteroscopy for hematuria, including 95 patients with UTUC and 307 patients with non-UTUC findings. Midstream morning urine samples were collected before ureteroscopy and surgery. DNA was extracted and qPCR was used to analyze mutations in TERT and FGFR3 and the methylation of NRN1. In the training set, the random forest algorithm was used to build an optimal panel. Lastly, the Beijing cohort (n = 76) was used to validate the panel. Results: The panel combining the methylation with mutation markers led to an AUC of 0.958 (95% CI: 0.933–0.975) with a sensitivity of 91.58% and a specificity of 94.79%. The panel presented a favorable diagnostic value for UTUC vs. other malignant tumors (AUC = 0.920) and UTUC vs. benign disease (AUC = 0.975). Furthermore, combining the panel with age revealed satisfactory results, with 93.68% sensitivity, 94.44% specificity, AUC = 0.970 and NPV = 98.6%. In the external validation process, the model showed an AUC of 0.971, a sensitivity of 95.83% and a specificity of 92.31, respectively. Conclusions: A novel diagnostic model for analyzing hematuria patients for the risk of UTUC was developed, which could lead to a reduction in the need for invasive examinations. Combining NRN1 methylation and gene mutation (FGFR3 and TERT) with age resulted in a validated accurate prediction model.
<b><i>Introduction:</i></b> The timing of surgical repair for ureterovaginal fistula (UVF) is under debate, here we introduce our experience to compare the safety and efficacy between early and delayed ureteral reimplantation for UVF. <b><i>Methods:</i></b> Between January 2012 and January 2020, 22 patients who were diagnosed with UVF had received ureteral reimplantation. Baseline characteristics, history of previous abdominal surgery, operative profile, and follow-up data were collected and analyzed. <b><i>Results:</i></b> Among 22 patients diagnosed with UVF, 12 patients received early ureteral reimplantation and others received delayed ureteral reimplantation. Both groups were comparable in baseline characteristics and detailed history of previous operations. The mean operative time of the early surgery group was 140.83 ± 35.28 min, while that of the delayed surgery group was 181.00 ± 43.83 min (<i>p</i> = 0.027). Patients of the early surgery group (183.33 ± 107.31 mL) had less blood loss compared with that of the delayed surgery group (285.00 ± 94.43 mL) (<i>p</i> = 0.030). After an overall mean follow-up of 34.55 months, the ureteral stricture rate of two groups was not statistically significantly different (16.67% in early repair vs. 40.00% in delayed repair, <i>p</i> = 0.348). <b><i>Conclusion:</i></b> With similar long-term outcomes, the early ureteral reimplantation had a shorter operative time and less blood loss. Moreover, the stress during the waiting period could be minimized. High-quality clinical studies with larger sample size are needed to confirm the superior nature of early surgery.
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