Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta‐analysis

Abstract

ObjectivesTo investigate whether ureteroscopy (URS) before radical nephroureterectomy (RNU) for upper tract urothelial carcinomas (UTUCs) has an impact on oncological outcomes. Patients and MethodsWe performed a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described URS performed on patients with UTUC and conducted a standard meta-analysis on survival outcomes. ResultsOur meta-analysis included eight eligible studies containing 3975 patients. The results were as follows: cancer-specific survival (CSS; hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59-0.99; P = 0.04), overall survival (OS; HR 0.76, 95% CI 0.48-1.21; P = 0.24), recurrence-free survival (RFS; HR 0.89, 95% CI 0.69-1.14; P = 0.37), metastasis-free survival (MFS; HR 1.06, 95% CI 0.82-1.36; P = 0.66), and intravesical recurrence-free survival (IRFS; HR 1.51, 95% CI 1.29-1.77; P < 0.001). When excluding previous bladder tumour history, the result for IRFS was a HR of 1.81 (95% CI 1.53-2.13; P < 0.001). ConclusionsThis meta-analysis indicated that URS before RNU did not have a negative impact on CSS, OS, RFS, or MFS in patients with UTUC. However, patients were at higher risk of intravesical recurrence after RNU when they had undergone URS before RNU. Further studies are needed to assess the effects of post-URS intravesical chemotherapy on intravesical recurrence.

High performance of 5‐aminolevulinic acid‐induced fluorescent selective upper tract urinary cytology

“…The sensitivity and specificity of white light are 53.5% and 95.2%, respectively, and using photodynamic diagnostic ureteroscopy with preoperative 5‐ALA medicine orally is more effective, as shown by the higher sensitivity and specificity of 95.8% and 96.6%, respectively . However, ureteroscopy is highly invasive, and there is an increased risk of tumor recurrence in the bladder after the examination . In contrast, 5‐ALA‐induced fluorescent selective upper tract urinary cytology can be carried out on outpatients, and has reduced invasiveness compared with ureteroscopy.…”

“…19 However, ureteroscopy is highly invasive, and there is an increased risk of tumor recurrence in the bladder after the examination. 20 In contrast, 5-ALA-induced fluorescent selective upper tract urinary cytology can be carried out on outpatients, and has reduced invasiveness compared with ureteroscopy. Furthermore, extracorporeal 5-ALA-induced fluorescent selective upper tract urinary cytology is less invasive for patients compared with taking 5-ALA medicine orally.…”

The predictive value of preoperative positive urine cytology for development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma: A retrospective multi-center case-control study and meta-analysis

“…In fact, as various risk factors correlated with intravesical recurrence have been found and analyzed, studies differ signi cantly in the identi cation of multifactorial prognosis. For patients with UUT-UC, a history of bladder cancer, tumor location in the ureter or tumor multifocality have been validated as prognostic factors in the recurrence of non-muscle-invasive bladder cancer [35][36][37]. The number of patients with multiple upper urothelial carcinomas who had recurrent urothelial carcinomas was signi cantly higher than that of patients with single urothelial carcinomas [38].…”

The challenge with systematic reviews of non‐randomised studies in urology

“…Guo et al. conducted sensitivity analyses to describe the potential for bias introduced by confounders of previous bladder tumour history and bladder‐cuff management, thereby increasing our confidence that the observed effect may be closer to the truth. It seems equally important to note that Guo et al.…”

“…While ureterorenoscopy before nephroureterectomy may indeed increase the risk of intravesical recurrence as the authors suggest, additional exploration would be needed to make a statement about the causality of the relationship. Guo et al [1] conducted sensitivity analyses to describe the potential for bias introduced by confounders of previous bladder tumour history and bladder-cuff management, thereby increasing our confidence that the observed effect may be closer to the truth. It seems equally important to note that Guo et al found no increased risk in cancer-specific,…”