AB064. Diagnostic ureteroscopy for upper tract urothelial carcinoma is independently associated with intravesical recurrence after radical nephroureterectomy

Objective: To determine the effect of diagnostic ureteroscopy on intravesical recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). Methods: We conducted a retrospective analysis of 664 patients who were treated with RNU for UTUC from June 2000 to December 2011, excluding those who had concomitant/prior bladder tumors. Of the 664 patients, 81 underwent diagnostic ureteroscopy (URS). We analyzed the impact of diagnostic ureteroscopy on intravesical recurrence (IVR) using the Kaplan-Meier method. Univariate and multivariate analyses were used to determine the independent risk factors. Results: The median follow-up time was 48 months [interquartile range (IQR): 31–77 months]. Patients who underwent ureteroscopy were more likely to have a small (P<0.01), early-staged (P=0.019), multifocality (p=0.035) and ureteral tumor (P<0.001). IVR occurred in 223 patients during follow-up within a median of 17 months (IQR: 7–33). Patients without preoperative ureteroscopy have a statistically significant better 2-year [(79.3±0.02)% vs. (71.4±0.02)%, P<0.001] and 5-year intravesical recurrence-free survival rates [(64.9±0.05)% vs. (44.3±0.06)%, P<0.001] than patients who underwent ureteroscopy. In multivariate analysis, the diagnostic ureteroscopy (P=0.006), multiple tumors (P=0.001), tumor size <3 cm (P=0.008), low-grade (P=0.022) and pN0 stage tumor (P=0.045) were independent predictors of IVR. Conclusions: Diagnostic ureteroscopy is independently associated with intravesical recurrence after radical nephroureterectomy.