Impact of diagnostic ureteral catheterization on intravesical tumour recurrence following radical nephroureterectomy for upper tract urothelial carcinoma

Yonese, Ichiro; Ito, M.; Waseda, Yuma; Kobayashi, Shuichiro; Toide, Masahiro; Takazawa, Ryoji; Koga, Fumitaka

doi:10.1007/s00345-023-04446-4

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…The proportions of IVR in patients with and without SVs were 30% and 40% respectively, comparable to outcomes in a recent single-centre study reporting IVR rates of 48% [10] as well as IVR rates of 42% in the control arm of a randomised trial [10,11].…”

Section: Discussionsupporting

confidence: 76%

Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy

Patras,

Abrahamsson,

Gerdtsson

et al. 2024

SJU

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Objective: Disease recurrence, particularly intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), is common. We investigated whether violations of onco-surgical principles before or during RNU, collectively referred to as surgical violation (SV), were associated with survival outcomes. Material and methods: Data from a consecutive series of patients who underwent RNU for UTUC 2001–2012 at Skåne University Hospital Lund/Malmö were collected. Preoperative insertion of a nephrostomy tube, opening the urinary tract during surgery or refraining from excising the distal ureter were considered as SVs. Survival outcomes in patients with and without SV (IVR-free [IVRFS], disease-specific [DSS] and overall survival [OS]) were assessed using multivariate Cox regression analyses (adjusted for tumour stage group, prior or concomitant bladder cancer, comorbidity and preoperative urinary cytology). Results: Of 150 patients, 47 (31%) were subjected to at least one SV. Overall, SV was not associated with IVRFS (HR 0.81, 95% CI 0.4–1.6) but with worse DSS (HR 1.9, 95% CI 1.03–3.7) and OS (HR 1.9, 95% CI 1.2–3) in multivariable analysis. Additional analyses with a broader definition of SV including also preoperative instrumentation of the upper urinary tract (ureteroscopy and/or double J stenting) showed similar outcomes for DSS (HR 2.1, 95% CI 1.1–4.3). Conclusion: Worse survival outcomes, despite no difference in IVR, for patients that were subjected to the violation of sound onco-surgical principles before or during RNU for UTUC strengthen the notion that adhering to such principles is a cornerstone in upper tract urothelial cancer surgery.

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Section: Discussionsupporting

confidence: 76%

Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy

Patras,

Abrahamsson,

Gerdtsson

et al. 2024

SJU

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“…Interestingly, URS and URSBx did not confer an additional risk of IVR in patients who had undergone ureteral catheterization in their study. 14 These results suggest that any diagnostic manipulation of the upper tract, even one that is minimally invasive, can increase the risk of IVR by promoting tumor cell spillage into the bladder. Notably, the pathological results for IVR (Table 3) showed that manipulation during URS may confer a risk of superficial, but not invasive bladder cancer recurrence.…”

Section: Discussionmentioning

confidence: 84%

“…Indeed, Izol et al 11 reported that IVR rate tended to be higher in the URSBx than in the URS group, but that the difference was not significant, and suggested that a larger sample may have led to a significant result. However, Yonese et al 14 reported that even minimally invasive ureteral catheterization for selective urine cytology and retrograde ureteropyelography is conducive to tumor cell spillage and the development of IVR. Interestingly, URS and URSBx did not confer an additional risk of IVR in patients who had undergone ureteral catheterization in their study.…”

Section: Discussionmentioning

confidence: 99%

The clinical impact of ureteroscopy for upper tract urothelial carcinoma: A multicenter study

Nakano,

Urabe,

Kiuchi

et al. 2023

Int J of Urology

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BackgroundWith the development of kidney‐sparing surgery and neoadjuvant chemotherapy, ureteroscopic biopsy (URSBx) has become important for the management of upper tract urothelial carcinoma (UTUC).MethodsWe retrospectively analyzed data from 744 patients with UTUC who underwent radical nephroureterectomy (RNU), stratified into no ureteroscopy (URS), URS alone, and URSBx groups. Intravesical recurrence‐free survival (IVRFS) was examined using the Kaplan–Meier method. We conducted Cox regression analyses to identify risk factors for IVR. We investigated differences between clinical and pathological staging to assess the ability to predict the pathological tumor stage and grade of RNU specimens.ResultsKaplan–Meier curves and multivariate Cox regression revealed significantly more IVR and inferior IVRFS in patients who underwent URS and URSBx. Superficial, but not invasive, bladder cancer recurrence was more frequent in the URS and URSBx groups than in the no URS group. Clinical and pathological staging agreed for 55 (32.4%) patients. Downstaging occurred for 48 (28.2%) patients and clinical understaging occurred for 67 (39.4%) patients. Upstaging to muscle‐invasive disease occurred for 39 (35.8%) of 109 patients with ≤cT1 disease. Clinical and pathological grading were similar for 72 (42.3%) patients. Downgrading occurred for 5 (2.9%) patients, and clinical undergrading occurred for 93 (54.7%) patients.ConclusionURS and URSBx instrumentation will be risk factors for superficial, but not invasive, bladder cancer recurrence. Clinical understaging/undergrading and upstaging to muscle‐invasive disease occurred for a large proportion of patients with UTUC who underwent RNU. These data emphasize the challenges involved in accurate UTUC staging and grading.

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“…The impact of a single dose of intravesical post-operative chemotherapy lowers the risk of intravesical recurrence [ 41 ] and could lead to a de-escalation of cystoscopies, but it is unclear to what extent. After KSS, the rate of IVR is likely to be higher due to many interventions with ureteroscopies, which have been shown to lead to higher rate of IVR due to presumed seeding [ 42 ].…”

Section: Current Surveillance Protocols After Rnumentioning

confidence: 99%

Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

Klemm,

Bekku,

Abufaraj

et al. 2023

Cancers

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Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.

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Impact of diagnostic ureteral catheterization on intravesical tumour recurrence following radical nephroureterectomy for upper tract urothelial carcinoma

Cited by 5 publications

References 25 publications

Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy

Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy

The clinical impact of ureteroscopy for upper tract urothelial carcinoma: A multicenter study

Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

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