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

doi:10.1016/j.urology.2021.11.026

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

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

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 language	English (US)
Pages (from-to)	142-146
Number of pages	5
Journal	Urology
Volume	160
DOIs	https://doi.org/10.1016/j.urology.2021.11.026
State	Published - Feb 2022
Externally published	Yes

Bibliographical note

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

Publisher Copyright:
© 2021 Elsevier Inc.

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10.1016/j.urology.2021.11.026

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Douglawi, A., Ghoreifi, A., Lee, R., Yip, W., Seyedian, S. S. L., Ahmadi, H., Cai, J., Miranda, G., Yu, W., Bhanvadia, S., Schuckman, A., Desai, M., Aron, M., Sotelo, R., Gill, I., Daneshmand, S., Fuchs, G., & Djaladat, H. (2022). Bladder Recurrence Following Diagnostic Ureteroscopy in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Cancer: Is Ureteral Access Sheath Protective? Urology, 160, 142-146. https://doi.org/10.1016/j.urology.2021.11.026

Douglawi, A, Ghoreifi, A, Lee, R, Yip, W, Seyedian, SSL, Ahmadi, H, Cai, J, Miranda, G, Yu, W, Bhanvadia, S, Schuckman, A, Desai, M, Aron, M, Sotelo, R, Gill, I, Daneshmand, S, Fuchs, G & Djaladat, H 2022, 'Bladder Recurrence Following Diagnostic Ureteroscopy in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Cancer: Is Ureteral Access Sheath Protective?', Urology, vol. 160, pp. 142-146. https://doi.org/10.1016/j.urology.2021.11.026

@article{313a33996d0849b391260c12808170e0,

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

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.",

author = "Antoin Douglawi and Alireza Ghoreifi and Ryan Lee and Wesley Yip and Seyedian, {Seyedeh Sanam Ladi} and Hamed Ahmadi and Jie Cai and Gus Miranda and Wenhao Yu and Sumeet Bhanvadia and Anne Schuckman and Mihir Desai and Monish Aron and Rene Sotelo and Inderbir Gill and Siamak Daneshmand and Gerhard Fuchs and Hooman Djaladat",

note = "Funding Information: Financial Disclosure: The authors declare that they have no relevant financial interests. Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2022",

month = feb,

doi = "10.1016/j.urology.2021.11.026",

language = "English (US)",

volume = "160",

pages = "142--146",

journal = "Urology",

issn = "0090-4295",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Bladder Recurrence Following Diagnostic Ureteroscopy in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Cancer

T2 - Is Ureteral Access Sheath Protective?

AU - Douglawi, Antoin

AU - Ghoreifi, Alireza

AU - Lee, Ryan

AU - Yip, Wesley

AU - Seyedian, Seyedeh Sanam Ladi

AU - Ahmadi, Hamed

AU - Cai, Jie

AU - Miranda, Gus

AU - Yu, Wenhao

AU - Bhanvadia, Sumeet

AU - Schuckman, Anne

AU - Desai, Mihir

AU - Aron, Monish

AU - Sotelo, Rene

AU - Gill, Inderbir

AU - Daneshmand, Siamak

AU - Fuchs, Gerhard

AU - Djaladat, Hooman

PY - 2022/2

Y1 - 2022/2

N2 - 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.

AB - 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.

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DO - 10.1016/j.urology.2021.11.026

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SN - 0090-4295

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JO - Urology

JF - Urology

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

Abstract

Bibliographical note

PubMed: MeSH publication types

UN SDGs

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