Bladder Recurrence Following Diagnostic Ureteroscopy in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Cancer: Is Ureteral Access Sheath Protective? - 22/02/22
, Alireza Ghoreifi, Ryan Lee, Wesley Yip, Seyedeh-Sanam Ladi Seyedian, Hamed Ahmadi, Jie Cai, Gus Miranda, Wenhao Yu, Sumeet Bhanvadia, Anne Schuckman, Mihir Desai, Monish Aron, Rene Sotelo, Inderbir Gill, Siamak Daneshmand, Gerhard Fuchs, Hooman DjaladatAbstract |
Objective |
To examine the effect of diagnostic ureteroscopy (URS) and ureteral access sheath usage on bladder recurrence following radical nephroureterectomy (RNU).
Methods |
We retrospectively reviewed the records of patients who underwent RNU between 2005 – 2019. Patients with a history of bladder cancer and those without a bladder cuff resection were excluded. Bladder recurrence was the primary outcome and cox regression modeling was used to assess the impact of URS adjusting for other factors.
Results |
Out of 271 RNU cases, 143 were included with a median age of 73 years (IQR 65 – 80). URS was performed in 104 cases (73%) and a ureteral access sheath was used in 26 (25%). With a median follow-up of 27 months, there were 36 (25%) bladder recurrences. The bladder recurrence rate (median time to recurrence) for patients who had URS vs no URS was 30.8% (9.0 months) and 7.7% (12.1 months), respectively (P = .02). A lower recurrence rate was noted in patients whom a ureteral access sheath was utilized (11.5%) vs those with no access sheath (39.7%, P = .01). Multivariable analysis revealed a significant increase in bladder recurrence if URS was performed prior to RNU (HR 5.6 [1.7 – 18.5], P <.004), however, this effect was mitigated if a ureteral access sheath was used (HR 1.3, [0.3 – 6.4], P = .76). Ureteral stent usage and performing a ureteroscopic biopsy had no significant effect on bladder recurrence.
Conclusion |
Diagnostic URS in patients undergoing RNU for UTUC significantly increases the risk of bladder recurrence. This effect may be mitigated by using a ureteral access sheath.
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| Financial Disclosure: The authors declare that they have no relevant financial interests. |
Vol 160
P. 142-146 - février 2022 Retour au numéro
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