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. 2015 Nov 10;10(11):e0139976.
doi: 10.1371/journal.pone.0139976. eCollection 2015.

Diagnostic Ureterorenoscopy Is Associated with Increased Intravesical Recurrence following Radical Nephroureterectomy in Upper Tract Urothelial Carcinoma

Hyun Hwan Sung  1 , Hwang Gyun Jeon  1 , Deok Hyun Han  1 , Byong Chang Jeong  1 , Seong Il Seo  1 , Hyun Moo Lee  1 , Han-Yong Choi  1 , Seong Soo Jeon  1
Affiliations

Diagnostic Ureterorenoscopy Is Associated with Increased Intravesical Recurrence following Radical Nephroureterectomy in Upper Tract Urothelial Carcinoma

Hyun Hwan Sung et al. PLoS One. .

Abstract

Diagnostic ureterorenoscopy is powerful tool to confirm upper tract urothelial cancer (UTUC). However, URS and associated manipulation may be related to the risk of intravesical recurrence (IVR) following radical nephroureterectomy (RNU). We aimed to investigate whether preoperative ureterorenoscopy would increase IVR after RNU in patients with UTUC. We performed a retrospective analysis of 630 patients who had RNU with bladder cuff excision due to UTUC. Diagnostic URS was performed in 282 patients (44.7%). Patients were divided into two groups according to the URS. Survival analysis and multivariate Cox regression model were performed to address risk factors for the IVR. The interval from URS to RNU was measured. During URS, manipulation such as biopsy and resection was determined. The median age was 64 (IQR 56-72) years with follow-up duration of 34.3 (15.7-64.9) months. Median time from URS to RNU was 16 (0-38) days. The IVR developed in 42.5% (n = 268) patients at 8.2 (4.9-14.7) months. The five-year IVR-free survival rate was 42.6 ± 8.0% and 63.6 ± 6.9% in patients with and without preoperative URS, respectively (P < 0.001). In multivariate analysis, previous history of bladder tumour, extravesical excision of distal ureter, multifocal tumour, and URS (HR, 95% CI; 1.558, 1.204-2.016, P = 0.001) were independent predictors for higher IVR. The IVR rate in patients without manipulation during URS was not different to those with manipulation (P = 0.658). The duration from URS to RNU was not associated with IVR (P = 0.799). Diagnostic URS for UTUC increased IVR rate after RNU. However, the lessening of interval from URS to radical surgery or URS without any manipulation could not reduce the IVR rate.

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Conflict of interest statement

Competing Interests: This study was supported by Samsung Medical Center, grant #CRS11115. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1
Survival analysis of intravesical recurrence in all patients (A), and according to previous bladder tumor history (B) following radical nephroureterectomy.
Fig 2
Fig 2. Survival analysis of intravesical recurrence according to preoperative ureterorenoscopy in all patients (A, n = 630) and excluding prior bladder tumor history (B, n = 507) following radical nephroureterectomy.
Fig 3
Fig 3. Survival analysis of intravesical recurrence according to manipulation.
mani, manipulation; URS, ureterorenoscopy; w, with; w/o, without.
Fig 4
Fig 4. Survival analysis of intravesical recurrence between concurrent ureterorenoscopy with radical nephroureterectomy group (n = 72) versus preceding ureterorenoscopy and delayed radical nephroureterectomy group (n = 210).
See this image and copyright information in PMC

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