Impact of double J stenting or nephrostomy placement during transurethral resection of bladder tumour on the incidence of metachronous upper urinary tract urothelial cancer

Abstract

Background: Whether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT) harms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development remains controversial. This study evaluated the impact of DJ compared to nephrostomy placement during TURBT for bladder cancer (BCa) on the incidence of metachronous UUTUCs. Methods:We retrospectively analysed 637 patients who underwent TURBT in our department between 2008 and 2016. BCa, UUTUC and urinary drainage data (retrograde/anterograde DJ and percutaneous nephrostomy) were assessed, along with the prevalence of hydronephrosis, and mortality. Chi-square and Fisher's exact test was performed for univariate analyses. Survival analysis was performed by the Kaplan-Meier method and log-rank tests.Results: UUTUC was noted in 28 out of 637 patients (4.4%), whereas only eight (1.3%) developed it metachronously to BCa. Out of these, four patients received DJ stents, while four patients received no urinary drainage of the upper urinary tract. Placement of urinary drainage significantly correlated with UUTUC (50.0% vs. 17.9%; p = 0.041). DJ stenting significantly correlated with UUTUC (50.0% vs. 11%; p < 0.01), while no patient with a nephrostomy tube developed UUTUC. UUTUC-free survival rates were significantly lower for patients with DJ stents than for all other patients (p = 0.001). Patients with or without DJ stents had similar overall survival (OS) rates (p = 0.73), whereas patients with nephrostomy tubes had significantly lower OS rates than all other patients (p < 0.001). Conclusions: Patients with DJ stenting during TURBT for BCa might have an increased risk of developing metachronous UUTUC. This study indicated advantages in placing nephrostomy tubes rather than DJ stents; however, confirmation requires investigation of a larger cohort. Even so, the increased mortality rate in the nephrostomy group reflected hydronephrosis as an unfavourable prognostic factor.

Comparison of Double J Stent Insertion and Percutaneous Nephrostomy Drainage Methods in Patients with Bladder Cancer in Terms of Metachronous Upper Urinary Tract Urothelial Cell Carcinoma Development: Retrospective Clinical Study

“…Hastaların ilk mesane tümörü tanısından itibaren medyan takip süresi 14,9 ay, drenaj uygulanmasından sonra ise medyan 12 aydır. 20 Bahsedilen 2 çalışma, sonuçlar ve çalışma dizaynı bakımından benzerdir. Kiss ve ark.…”

“…7 Başlangıç tümör derecesine bağlı olarak tedaviyi takiben ÜÜST hastalarının %22-47'sinde mesanede nüks meydana gelirken, %2-5 oranında karşı taraf üst üriner sistemde nüks görülür. 8,9 Literatürde yüzeyel MK hastaların takiplerinde değişen oranlarda (%2, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] metakron ÜÜST bildirilirken, sistektomi yapılan kas invaziv MK hastalarında metakron ÜÜST gelişimi ise %2-8 oranlarında bildirilmiştir. [10][11][12][13][14][15] MK nedeniyle yapılan transüretral rezeksiyon sırasında, üreter orifisi rezeksiyonunu takiben üreter orifis ağzının kapanmasını engellemek amacıyla ya da hidronefroz nedeniyle dekompresyon amaçlı double J stent (DJS) uygulanan hastalarda üst üriner sisteme tümör hücresi ekilim riski endişeleri bulunmaktadır.…”

Transurethrale Resektion von Blasentumoren (TUR-B)

“…Eine retrograde Darstellung oder Harnleiterschienung sollte bei Tumornachweis in der Blase nur mit Zurückhaltung erfolgen. Im Falle einer begleitenden Harnstauungsniere ist die Nephrostomieanlage

Nephrostomieanlage

mit antegrader Abklärung vorzuziehen, wobei die Datenlage hierzu schwach ist [ 20 ].…”

Transurethral resection of bladder cancer involving the orifice of the ureter

“…У пациентов со стентами и без них были сопоставимыми показатели общей выживаемости (р = 0,73), тогда как у пациентов с нефростомой общая выживаемость была статистически значимо ниже, чем у всех остальных пациентов (р < 0,001). По мнению авторов, при стентировании после ТУР имеется повышенный риск развития метахронного УРВМП [26,54]. Таким образом, мнения о целесообразности интраоперационного стентирования мочеточника сразу после ТУР устья остаются противоречивыми, хотя большинство урологов склоняется к тому, что его следует использовать только в исключительных случаях.…”

“…Для РМП характерна высокая кумулятивная частота мультифокальных рецидивов, рассеянных по всему мочеполовому тракту [22]. Метахронный УРВМП возникает, как правило, через 3 и более года после первичного РМП, и его частота после радикальной цистэктомии колеблется от 1,3 до 10,0 % [22][23][24][25][26]. Частота рецидивов УРВМП после трансуретральной резекции (ТУР) редко превышает 5 % [17,27], но в некоторых исследованиях доходит до 13 % [28] и даже 25 % [29].…”