Bladder Recurrence Following Diagnostic Ureteroscopy in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Cancer: Is Ureteral Access Sheath Protective?

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

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Abstract

OBJECTIVE: To examine the effect of diagnostic ureteroscopy (URS) and ureteral access sheath usage on bladder recurrence following radical nephroureterectomy (RNU).

METHODS: 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.

RESULTS: 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 = .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 = .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 <.004), however, this effect was mitigated if a ureteral access sheath was used (HR 1.3, [0.3 - 6.4], P = .76). Ureteral stent usage and performing a ureteroscopic biopsy had no significant effect on bladder recurrence.

CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)142-146
Number of pages5
JournalUrology
Volume160
DOIs
StatePublished - Feb 2022
Externally publishedYes

Bibliographical note

Funding Information:
Financial Disclosure: The authors declare that they have no relevant financial interests.

Publisher Copyright:
© 2021 Elsevier Inc.

PubMed: MeSH publication types

  • Journal Article

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