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Early repeated ureteroscopy within 6–8 weeks after a primary endoscopic treatment in patients with upper tract urothelial cell carcinoma: preliminary findings

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Abstract

Objectives

To evaluate the cancer detection rate (CDR) of an early repeated flexible ureteroscopy (2nd-look-URS) and its impact on the conservative management of patients affected with upper urinary tract urothelial carcinoma (UTUC).

Materials and methods

Clinical and surgical data from 41 patients with UTUC who underwent 2nd-look-URS within 60 days of their first URS with concomitant laser tumour photoablation at a single tertiary care referral centre from 2009 to 2013 were retrospectively analyzed. Radical nephroureterectomy was offered during follow-up in case of massive tumour recurrence (defined as a tumour not completely removable only with a conservative approach). Descriptive statistics tested the impact of 2nd-look-URS outcomes on subsequent endoscopic evaluation. Kaplan–Meier curves assessed massive tumour recurrence-free survival (mRFS) rates according to the presence of a tumour at 2nd-look-URS. Cox regression analyses identified predictors of mRFS.

Results

CDR at 2nd-look-URS was 51.2 %. CDRs at third URS were 81.3 and 41.2 % in patients with a positive and a negative 2nd-look-URS, respectively (p = 0.02). At a mean (median) follow-up of 34.6 (27.6) months, mRFS rates were 88 and 48 % in patients with negative and positive 2nd-look-URS, respectively (log rank = 0.015). Tumour grade at first URS and 2nd-look-URS outcomes achieved predictor status for mRFS (HR 6.1, 95 % CI 1.42–26.27 and HR 5.39, 95 % CI 1.18–24.66, respectively, all p ≤ 0.03).

Conclusions

2nd-look-URS-related CDR in conservatively treated UTUC patients was 51.2 %. 2nd-look-URS outcomes affected the findings of both subsequent endoscopic evaluation and mRFS. Further studies are needed to confirm the benefits of this approach in terms of patient outcomes.

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Author’s contribution

Villa contributed to manuscript writing, data collection and analysis; Cloutier involved in data collection and management; Letendre contributed to protocol and project development; Ploumidis participated in data collection and manuscript editing; Salonia involved in data analysis and data management; Cornu contributed to manuscript writing and data analysis; Montorsi involved in manuscript editing and protocol; Traxer contributed to protocol development, data collection, manuscript editing.

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Authors and Affiliations

  1. Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France

    Luca Villa, Jonathan Cloutier, Julien Letendre, Achilles Ploumidis, Jean-Nicolas Cornu & Olivier Traxer

  2. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Luca Villa, Andrea Salonia & Francesco Montorsi

  3. Università Vita-Salute San Raffaele, Milan, Italy

    Andrea Salonia & Francesco Montorsi

Authors
  1. Luca Villa
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  2. Jonathan Cloutier
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  3. Julien Letendre
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  5. Andrea Salonia
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  6. Jean-Nicolas Cornu
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  7. Francesco Montorsi
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  8. Olivier Traxer
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Correspondence to Olivier Traxer.

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Conflict of interest

Olivier TRAXER is consultant for Olympus, Coloplast, Boston Scientific, Rocamed. Other authors declare no conflict of interest regarding this paper.

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We respected the ethical standards existed in the hospital and university of Tenon Hospital.

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Villa, L., Cloutier, J., Letendre, J. et al. Early repeated ureteroscopy within 6–8 weeks after a primary endoscopic treatment in patients with upper tract urothelial cell carcinoma: preliminary findings. World J Urol 34, 1201–1206 (2016). https://doi.org/10.1007/s00345-015-1753-7

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  • DOI: https://doi.org/10.1007/s00345-015-1753-7

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