To examine the effect of diagnostic ureteroscopy (URS) and ureteral access sheath usage on bladder recurrence following radical nephroureterectomy (RNU).
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.
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=0.02). 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=0.01). Multivariable analysis revealed a significant increase in bladder recurrence if URS was performed prior to RNU (HR 5.6 [1.7-18.5], p<0.004), however, this effect was mitigated if a ureteral access sheath was used (HR 1.3, [0.3-6.4], p=0.76). Ureteral stent usage and performing a ureteroscopic biopsy had no significant effect on bladder recurrence.
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.
Urology. 2021 Dec 17 [Epub ahead of print]
Antoin Douglawi, 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 Djaladat
Keck School of Medicine of USC, Los Angeles. Electronic address: ., Keck School of Medicine of USC, Los Angeles.