Cancer - Bladder, Pelvis, Ureter & Others(구연) (E-063)
Retrograde uretero-pyelography without diagnostic ureteroscopy has superior intravesical recurrence-free survival compared to performing diagnostic ureteroscopy in radical nephrouretrectomy for UTUC
순천향대학교 의과대학 비뇨의학과교실
김기홍, 김시현, 양희조, 김두상, 이창호, 전윤수
Objectives:
Ureteroscopy prior to nephroureterectomy (NU) is a practical and powerful tool to diagnose upper urinary tract urothelial carcinomas (UTUC). However, ureteroscopy before NU has a potential limitation which could pose a risk factor for intra-vesical recurrence. Therefore, we tried to identify the risk factor of intra-vesical recurrence after NU, and to investigate whether retrograde uretero-pyelography (RGP) without diagnostic ureteroscopy could be another diagnostic option in UTUC.

Patients and methods:
From total 77 UTUC patients who underwent NU, 65 patients were finally enrolled in this study, 12 patients who underwent NU without further evaluation after a computed tomography examination were excluded. Univariate and multivariate analyses based on Cox’s regression were performed to identify independent prognostic factors for intravesical recurrence-free survival (IVRFS) after NU.

Results:
From the total 65 patients, 32 patients have underwent diagnostic ureteroscopy and 33 patients have underwent RGP without ureteroscopy before nephroureterectomy. Patients who received RGP without diagnostic ureteroscopy were found to have significantly superior IVRFS compared to patients who received diagnostic ureteroscopy by Kaplan-Meier curve analysis (p = 0.002). RGP without ureteroscopy before nephroureterecomy (hazard ratio, 0.388; p = 0.030) was a significant independent predictor of IVRFS after radical nephroureterectomy.

Conclusions:
The diagnostic ureteroscopy procedure prior to nephrouretrectomy has a significant effect on IVRFS. RGP without diagnostic ureteroscopy can be another diagnostic option to reduce intravesical recurrence after NU in UTUC.
keywords : Retrograde uretero-pyelography, upper urinary tract urothelial carcinoma, intravesical recurrence

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