Prophylactic Intravesical Chemotherapy to Prevent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis

<b><i>Introduction:</i></b> Intravesical recurrence after treatment of primary upper urinary tract urothelial carcinomas (UUT-UCs) is common. While intravesical instillation is widely used to prevent recurrence after transurethral resection for primary bladder tumors, there is still no consensus on the prophylactic capability of intravesical chemotherapy in preventing bladder tumor recurrence after surgery for UUT-UCs. <b><i>Methods:</i></b> A meta-analysis of the published results of clinical trials was performed to compare radical surgery alone or surgery plus postoperative intravesical chemotherapy. The primary end point was to determine the percentage of patients with recurrence in the different groups. <b><i>Results:</i></b> Our study includes five trials with recurrence information on 614 patients. During follow-up, 55 of 268 (20.5%) patients who received postoperative instillation had bladder recurrence compared to 127 of 346 (36.7%) patients who had no adjuvant treatment - a decrease of 41% in the odds of recurrence with chemotherapy (odds ratio 0.48, 95% confidence interval 0.33-0.69, p = 0.0001). No serious adverse events were reported. Subgroup analyses were temporarily unavailable. <b><i>Conclusions:</i></b> Postoperative intravesical chemotherapy significantly decreases the risk of bladder recurrence after nephroureterectomy for primary UUT-UCs. Postoperative intravesical instillation is considered the treatment of choice after nephroureterectomy.