Skip to main content

Advertisement

SpringerLink
Log in

Is bladder preservation safe? The oncology outcomes of patients after 2-sided radical nephroureterectomies due to bilateral upper urinary tract urothelial carcinomas

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

The prognosis of patients undergoing 2-sided radical nephroureterectomies (RNUs) with a residual bladder due to bilateral upper tract urothelial carcinoma (UTUC) is poorly understood. This study was aimed toward surveying the oncology outcomes and prognostic factors that may help in shared decision-making related to bladder preservation in patients preparing to receive 2-sided RNUs.

Methods

Patients with synchronous or metachronous bilateral UTUC who received bilateral RNUs with a residual bladder in our hospital were retrospectively reviewed. Clinical and pathological data were analyzed for potential variables affecting the oncology outcomes.

Results

A total of 50 patients were included. The average age at completion of the 2-sided RNU was 62.7 ± 12.4 years, with a mean follow-up of 88.4 ± 59.3 months after the 2-sided RNUs. The medium overall survival was 13.4 ± 1.8 years. Twenty-six patients (52%) had cancer recurrence in the residual bladder, but only 2 (8%) of the recurrences were muscle invasive. The highest UTUC stage was the only predictive factor for cancer-specific survival (CSS) rather than intravesical recurrence. The 5 year CSS rates in patients with the highest UTUC stage ≦ pT2 and ≧ pT3 were 90% and 51%, respectively (p = 0.007).

Conclusions

Risk of cancer recurrence in the residual bladder is high, but does not affect survival outcomes. The highest UTUC stage plays a significant role in cancer-specific survival. With a careful patient surveillance, bladder preservation may be reasonable in patients with bilateral UTUC preparing for 2-sided RNUs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Roupret M, Babjuk M, Comperat E et al (2018) European Association of Urology Guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol 73:111–122

    Article  Google Scholar 

  2. Li Q, Assel M, Benfante N et al (2017) Clinical outcomes in patients with panurothelial carcinoma treated with radical nephroureterectomy following cystectomy for metachronous recurrence. J Urol 198:546–551

    Article  Google Scholar 

  3. Margulis V, Shariat SF, Matin SF et al (2009) Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer 115:1224–1233

    Article  Google Scholar 

  4. Holmäng S, Johansson SL (2006) Bilateral metachronous ureteral and renal pelvic carcinomas: incidence, clinical presentation, histopathology, treatment and outcome. J Urol 175:69–72 (discussion 72–63)

    Article  Google Scholar 

  5. Ou CH, Yang WH (2017) Long-term outcomes of complete urinary tract exenteration for dialysis patients with urothelial cancer. Int Urol Nephrol 49:623–627

    Article  Google Scholar 

  6. Holmang S, Johansson SL (2006) Bilateral metachronous ureteral and renal pelvic carcinomas: incidence, clinical presentation, histopathology, treatment and outcome. J Urol 175:69–72

    Article  Google Scholar 

  7. Fang D, Xiong G, Li X et al (2015) Incidence, characteristics, treatment strategies, and oncologic outcomes of synchronous bilateral upper tract urothelial carcinoma in the Chinese population. Urol Oncol 33:66.e61–11

    Article  Google Scholar 

  8. Chen CJ, Chuang YC, You SL, Lin TM, Wu HY (1986) A retrospective study on malignant neoplasms of bladder, lung and liver in blackfoot disease endemic area in Taiwan. Br J Cancer 53:399–405

    Article  CAS  Google Scholar 

  9. Rouprêt M, Yates DR, Comperat E, Cussenot O (2008) Upper urinary tract urothelial cell carcinomas and other urological malignancies involved in the hereditary nonpolyposis colorectal cancer (lynch syndrome) tumor spectrum. Eur Urol 54:1226–1236

    Article  Google Scholar 

  10. Kallidonis P, Liatsikos E (2021) Urothelial tumors of the upper urinary tract and ureter. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA (eds) Campbell Walsh Wein urology, vol 2, 12th edn. Elsevier, Philadelphia, p 2195

    Google Scholar 

  11. Yamashita S, Ito A, Mitsuzuka K et al (2016) Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 23:378–384

    Article  Google Scholar 

  12. Xylinas E, Colin P, Audenet F et al (2013) Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study. World J Urol 31:61–68

    Article  Google Scholar 

  13. Kakizoe T, Fujita J, Murase T, Matsumoto K, Kishi K (1980) Transitional cell carcinoma of the bladder in patients with renal pelvic and ureteral cancer. J Urol 124:17–19

    Article  CAS  Google Scholar 

  14. Seisen T, Granger B, Colin P et al (2015) A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol 67:1122–1133

    Article  Google Scholar 

  15. Azémar MD, Comperat E, Richard F, Cussenot O, Rouprêt M (2011) Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol 29:130–136

    Article  Google Scholar 

  16. Chen CH, Dickman KG, Huang CY et al (2013) Aristolochic acid-induced upper tract urothelial carcinoma in Taiwan: clinical characteristics and outcomes. Int J Cancer 133:14–20

    Article  CAS  Google Scholar 

  17. Van Ypersele De Strihou C, Jadoul M (2002) Progression rate of Chinese herb nephropathy: impact of Aristolochia fangchi ingested dose. Nephrol Dial Transplant 17:1852

    Article  Google Scholar 

  18. Nortier JL, Vanherweghem JL (2007) For patients taking herbal therapy–lessons from aristolochic acid nephropathy. Nephrol Dial Transplant 22:1512–1517

    Article  CAS  Google Scholar 

  19. Luo HL, Ohyama C, Hatakeyama S et al (2020) Unusual presentation of upper urinary tract urothelial carcinoma in Taiwan: Direct comparison from Taiwan–Japan UTUC Collaboration Cohort. Int J Urol 27:327–332

    Article  Google Scholar 

  20. Kallidonis P, Liatsikos E (2021) Urothelial tumors of the upper urinary tract and ureter. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA (eds) Campbell Walsh Wein urology, vol 2, 12th edn. Elsevier, Philadelphia, p 2187

    Google Scholar 

  21. Sinicrope FA (2018) Lynch syndrome-associated colorectal cancer. N Engl J Med 379:764–773

    Article  CAS  Google Scholar 

  22. Singh S, Resnick KE (2017) Lynch syndrome and endometrial cancer. South Med J 110:265–269

    Article  Google Scholar 

  23. Tan LB, Chen KT, Guo HR (2008) Clinical and epidemiological features of patients with genitourinary tract tumour in a blackfoot disease endemic area of Taiwan. BJU Int 102:48–54

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful to the funding agency for grant support: National Cheng Kung University Hospital (NCKUH-11003038).

Author information

Authors and Affiliations

  1. Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan

    Yao-Lin Kao, Wen-Horng Yang & Chien-Hui Ou

Authors
  1. Yao-Lin Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-Horng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chien-Hui Ou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: C-HO. Data curation: Y-LK. Formal analysis: Y-LK. Investigation: Y-LK. Methodology: Y-LK. Resources: C-HO. Supervision: W-HY. Writing—original draft: Y-LK. Writing—review and editing: W-HY and C-HO. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Chien-Hui Ou.

Ethics declarations

Conflicts of interest

The authors declare no conflicts of interest.

Ethics approval

The study was commenced after approval from the Institutional Review Board of National Cheng Kung University Hospital (NCKUH; A-ER-103-036).

Consent to participate

Not applicable.

Consent for publication

Informed consent was waived due to the retrospective nature of the data analysis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kao, YL., Yang, WH. & Ou, CH. Is bladder preservation safe? The oncology outcomes of patients after 2-sided radical nephroureterectomies due to bilateral upper urinary tract urothelial carcinomas. Int Urol Nephrol 54, 63–69 (2022). https://doi.org/10.1007/s11255-021-03005-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-021-03005-3

Keywords

Search

Navigation