Impact of post‐void residual urine volume on intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma

Abstract

Abbreviations & Acronyms BPH = benign prostatic hyperplasia CI = confidence interval GC = gemcitabine, cisplatin HR = hazard ratio LUTS = lower urinary tract symptoms PSM = propensity scorematching RFS = recurrence-free survival TUR-P = transurethral resection of the prostate UC = urothelial carcinoma UUT-UC = upper urinary tract urothelial carcinoma Objective: To examine the impact of post-void residual urine volume on the risk of postoperative recurrence of intravesical carcinoma in patients with upper urinary tract urothelial carcinoma undergoing nephroureterectomy. Methods: We retrospectively reviewed the data of 81 patients who were admitted to Chiba University Graduate School of Medicine Hospital and underwent nephroureterectomy for upper urinary tract urothelial carcinoma without bladder carcinoma. We assessed the predictive factors for intravesical recurrence after nephroureterectomy in all patients. Next, we compared patients with and without a residual urine volume using propensity score-matching analysis. The presence of a residual urine volume was defined as ≥30 mL. Results: The median follow-up period among all patients was 48 months. The presence of pyuria and a residual urine volume were associated with bladder recurrence in the multivariate analysis. A total of 19 patients each were selected after matching, and we confirmed a significant difference between the presence and absence of a residual urine volume (P = 0.0291). The 2-year postoperative recurrence-free rate of patients with and without a residual urine volume was 32% and 82%, respectively. Conclusions: This is the first study to evaluate the post-void residual urine volume and intravesical recurrence rate after nephroureterectomy for upper urinary tract urothelial carcinoma. The presence of residual urine might be a risk factor for postoperative recurrence of intravesical carcinoma.

Relationship between post‐void residual urine volume, preoperative pyuria and intravesical recurrence after transurethral resection of bladder carcinoma

“…This result suggests that not only residual urine, but also pyuria and residual urine contribute to the recurrence of cancer. 4 The pathways of recurrence or multifocality of urothelial carcinoma have been considered. The monoclonality hypothesis and field cancerization hypothesis were reported.…”

“…The presence of a residual urine volume was defined as ≥30 mL according to our previous report. 4 The presence of pyuria was defined as ≥10 white blood cells per high-powered field at the time before TUR-Bt.…”

“…3 We previously showed that the presence of residual urine and pyuria were risk factors for intravesical recurrence after nephroureterectomy for UUTUC. 4 One of the hypotheses is the implantation of tumor cells on the altered urothelial surface after nephroureterectomy. In addition, our previous study showed that intravesical irrigation during laparoscopic UUTUC operation lowered the incidence of postoperative bladder tumor recurrence.…”

Editorial Comment from Dr Kojima to Relationship between post‐void residual urine volume, preoperative pyuria and intravesical recurrence after transurethral resection of bladder carcinoma

“…1 The authors previously showed that the presence of residual urine and pyuria were risk factors for intravesical recurrence after nephroureterectomy for upper urinary tract carcinoma. 2 In this article, they showed that the presence of residual urine and pyuria were two independent prognostic factors for intravesical recurrence after transurethral resection of non-muscle invasive bladder cancer, as shown in upper urinary tract carcinoma. After patients were classified into risk groups, the poor-risk group (patients with both pyuria and residual urine) showed a significantly short recurrencefree survival compared with that of the good-(patients with neither of them) and intermediate-risk groups (patients with either one).…”

Editorial Comment to Impact of post‐void residual urine volume on intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma

“…Sazuka et al . investigated the association between post‐void residual urinary volume and IVR after RNU, and concluded that the presence of residual urine (defined as ≥30 mL) might be a hotbed of IVR . Although the definition of “presence” of a post‐void residual volume of 30 mL requires further investigation, their findings showed that non‐severe residual volumes are associated with a higher risk of IVR after RNU.…”