Pd7-11 Spontaneous Voiding Is Surprisingly Recoverable via Outlet Procedure After Documented Underactive Bladder on Urodynamics

Abstract

INTRODUCTION AND OBJECTIVES: It is unusual to diagnose a urothelial cell carcinoma in the intramural ureter based on the visualization of papillae in the ureteral meatus or as an incidental finding during the transurethral resection of a bladder tumour (TURBT) adjacent to the ureteral meatus. We analyse the incidence of stenosis and upper urinary tract tumours (UTUC) after TURBT/excision of the intramural portion of the distal ureter and/or bladder cancer.METHODS: 112 patients, with a mean age of 69.3AE13 years and a mean follow-up of 56AE4 months, underwent TUR of the intramuralureter and were diagnosed with non-muscle-invasive bladder cancer (NMIBC) at that location: 58% of cases were concomitant with primary tumours. The TUR specimen of the ureteral meatus was always sent separately for histological analysis. In patients with apparent tumour remaining in the distal ureter, ureterorenoscopy was performed at 3e4 months. A double J catheter was left in patients undergoing extensive resection of the trigone area (32.1%). 22.3% and 75.9% of patients received mitomycin and BCG respectively.RESULTS: Pathological examination revealed Ta in 64%, T1 in 22.3% and CIS in 17%.17 patients (15.2%) developed UTUC, which was located in the distal ureter in 65.4%, and 13 (11.6%) a distal ureteral stenosis. The presence of a ureteral catheter did not influence the outcome (23% vs 33%, p¼0.45). In univariate analysis, statistically significant differences were observed between primary and recurrent tumours with respect to the incidence of symptoms (60% vs 26%, p<0.001), development of ureteral stenosis (4.6% vs 21.3%, p¼0.007) and incidence of UTUC (4.6% vs 29.8%, p<0.001). Risk of development of UTUC increased significantly in accordance with the grade: the incidence was 30.3% in G3 tumours and 37.5% in CIS of the bladder, and 26.5% in G3 tumours and 66.7% in CIS in the distal ureter (p¼0.001). Multivariate logistic regression analysis demonstrated that presence of CIS in the meatus was predictive of UTUC (p¼0.003; 95% CI 0.003e0.31). Moreover, presence of tumours !3 cm was also predictive of secondary stenosis in multivariate logistic regression analysis (p¼0.04; 95% CI 0.19e0.64) CONCLUSIONS: NMIBC of the intramural ureter is an uncommon event. In multivariate analysis, tumours >3 cm were associated with a higher likelihood of development of distal ureteral stenosis and CIS of the intramural portion increased the risk of UTUC.Closer follow-up of should be undertaken since these factors are associated with a higher incidence of upper urinary tract problems.