Stenting Prior to Cystectomy is an Independent Risk Factor for Upper Urinary Tract Recurrence

No AccessJournal of UrologyAdult Urology1 Dec 2017Stenting Prior to Cystectomy is an Independent Risk Factor for Upper Urinary Tract Recurrence Bernhard Kiss, Marc A. Furrer, Patrick Y. Wuethrich, Fiona C. Burkhard, George N. Thalmann, and Beat Roth Bernhard KissBernhard Kiss Equal study contribution. More articles by this author , Marc A. FurrerMarc A. Furrer Equal study contribution. More articles by this author , Patrick Y. WuethrichPatrick Y. Wuethrich More articles by this author , Fiona C. BurkhardFiona C. Burkhard More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Beat RothBeat Roth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.06.020AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Patients with bladder cancer who present with hydronephrosis may require drainage of the affected kidney before receiving further cancer treatment. Drainage can be done by retrograde stenting or percutaneously. However, retrograde stenting carries the risk of tumor cell spillage to the upper urinary tract. The aim of this study was to evaluate whether patients with bladder cancer are at higher risk for upper urinary tract recurrence if retrograde stenting has been performed prior to radical cystectomy. Materials and Methods: We retrospectively analyzed the records of 1,005 consecutive patients with bladder cancer who underwent radical cystectomy at our department between January 2000 and June 2016. Negative intraoperative ureteral margins were mandatory for study inclusion. Patients received regular followup according to our institutional protocol, including imaging of the upper urinary tract and urine cytology. Results: Preoperative drainage of the upper urinary tract was performed in 114 of the 1,005 patients (11%), including in 53 (46%) by Double-J® stenting and in 61 (54%) by percutaneous nephrostomy. Recurrence developed in the upper urinary tract in 31 patients (3%) at a median of 17 months after cystectomy, including 7 of 53 (13%) in the Double-J group, 0% in the nephrostomy group and 24 of 891 (3%) in the no drainage group. Multivariate regression analysis revealed a higher risk of upper urinary tract recurrence if patients underwent Double-J stenting (HR 4.54, 95% CI 1.43–14.38, p = 0.01) and preoperative intravesical instillations (HR 2.94, 95% CI 1.40–6.16, p = 0.004). Conclusions: Patients who undergo Double-J stenting prior to radical cystectomy are at higher risk for upper urinary tract recurrence. If preoperative upper urinary tract drainage is required, percutaneous drainage might be recommended. References 1 : The significance of ureteral obstruction in invasive transitional cell carcinoma of the urinary bladder. J Surg Oncol1993; 52: 31. Google Scholar 2 : Hydronephrosis as a prognostic marker in bladder cancer in a cystectomy-only series. Eur Urol2007; 51: 690. Google Scholar 3 : Preoperative hydronephrosis as an indicator of survival after radical cystectomy. Urol Oncol2009; 27: 491. Google Scholar 4 : Renal injury and recovery in partial ureteric obstruction. J Urol1989; 142: 199. Link, Google Scholar 5 : Kuhn's paradigms: are those closest to treating bladder cancer the last to appreciate the paradigm shift?. J Clin Oncol2011; 29: 2135. Google Scholar 6 : Percutaneous nephrostomy versus indwelling ureteral stents in the management of extrinsic ureteral obstruction in advanced malignancies: are there differences?. Urology2004; 64: 895. Google Scholar 7 : Malignant ureteral obstruction: outcomes after intervention. Have things changed?. J Urol2007; 178: 178. Link, Google Scholar 8 : Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J Urol2006; 176: 161. Link, Google Scholar 9 : Do patients benefit from routine follow-up to detect recurrences after radical cystectomy and ileal orthotopic bladder substitution?. Eur Urol2010; 58: 486. Google Scholar 10 : The efficiency of excretory urography to detect upper urinary tract tumors after cystectomy for urothelial cancer. J Urol2007; 178: 2287. Link, Google Scholar 11 : Upper tract urothelial tumor after transurethral resection for bladder tumor. Eur Urol1992; 21: 110. Crossref, Medline, Google Scholar 12 : Upper urinary tract recurrence following radical cystectomy for bladder cancer: a meta-analysis on 13,185 patients. J Urol2012; 188: 2046. Link, Google Scholar 13 : Upper urinary tract recurrence after radical cystectomy for bladder cancer—who is at risk?. J Urol2009; 182: 2632. Link, Google Scholar 14 : Systematic review on the fate of the remnant urothelium after radical cystectomy. Eur Urol2017; 71: 545. Google Scholar 15 : Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. ICUD-EAU International Consultation on Bladder Cancer 2012. Eur Urol2013; 63: 45. Google Scholar 16 : Late recurrence after radical cystectomy: patterns, risk factors and outcomes. J Urol2014; 191: 1256. Link, Google Scholar 17 : Clonal origin bladder cancer. N Engl J Med1992; 326: 737. Crossref, Medline, Google Scholar 18 : C-erbB-2 amplification and identical p53 mutations in concomitant transitional carcinomas of renal pelvis and urinary bladder. Lancet1992; 339: 439. Google Scholar 19 : Metachronous multifocal development of urothelial cancers by intraluminal seeding. Lancet1993; 342: 1087. Crossref, Medline, Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFurrer M, Kiss B, Studer U, Wuethrich P, Gahl B, Seiler R, Roth B, Bosshard P, Thomas B, Burkhard F, Boxler S and Thalmann G (2021) Seminal Vesical Sparing Cystectomy for Bladder Cancer is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center StudyJournal of Urology, VOL. 205, NO. 6, (1629-1640), Online publication date: 1-Jun-2021.Sountoulides P, Pyrgidis N, Brookman-May S, Mykoniatis I, Karasavvidis T and Hatzichristou D (2020) Does Ureteral Stenting Increase the Risk of Metachronous Upper Tract Urothelial Carcinoma in Patients with Bladder Tumors? A Systematic Review and Meta-analysisJournal of Urology, VOL. 205, NO. 4, (956-966), Online publication date: 1-Apr-2021.Chang S (2019) Re: Characterization of Late Recurrence after Radical Cystectomy in a Large Multicenter Cohort of Bladder Cancer PatientsJournal of Urology, VOL. 202, NO. 2, (209-209), Online publication date: 1-Aug-2019.Nouhaud F, Cornu J and Pfister C (2018) Re: Preoperatively Dilated Ureters are a Specific Risk Factor for the Development of Ureteroenteric Strictures after Open Radical Cystectomy and Ileal NeobladderJournal of Urology, VOL. 199, NO. 6, (1635-1637), Online publication date: 1-Jun-2018. Volume 198Issue 6December 2017Page: 1263-1268Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordslocalurinary bladder neoplasmsnephrostomyneoplasm recurrencecystectomystentspercutaneousMetricsAuthor Information Bernhard Kiss Equal study contribution. More articles by this author Marc A. Furrer Equal study contribution. More articles by this author Patrick Y. Wuethrich More articles by this author Fiona C. Burkhard More articles by this author George N. Thalmann More articles by this author Beat Roth More articles by this author Expand All Advertisement PDF downloadLoading ...