Stenting Prior to Cystectomy is an Independent Risk Factor for Upper Urinary Tract Recurrence.

Kiss, Bernhard; Furrer, Marc; Wüthrich, Patrick Yves; Burkhard, Fiona C.; Thalmann, George; Roth, Beat (2017). Stenting Prior to Cystectomy is an Independent Risk Factor for Upper Urinary Tract Recurrence. The journal of urology, 198(6), pp. 1263-1268. Elsevier 10.1016/j.juro.2017.06.020

[img] Text
1-s2.0-S0022534717747520-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (191kB) | Request a copy

PURPOSE Patients with bladder cancer who present with hydronephrosis may require drainage of the affected kidney before receiving further cancer treatment. Drainage can be done by retrograde stenting or percutaneously. However, retrograde stenting carries the risk of tumor cell spillage to the upper urinary tract. The aim of this study was to evaluate whether patients with bladder cancer are at higher risk for upper urinary tract recurrence if retrograde stenting has been performed prior to radical cystectomy. MATERIALS AND METHODS We retrospectively analyzed the records of 1,005 consecutive patients with bladder cancer who underwent radical cystectomy at our department between January 2000 and June 2016. Negative intraoperative ureteral margins were mandatory for study inclusion. Patients received regular followup according to our institutional protocol, including imaging of the upper urinary tract and urine cytology. RESULTS Preoperative drainage of the upper urinary tract was performed in 114 of the 1,005 patients (11%), including in 53 (46%) by Double-J® stenting and in 61 (54%) by percutaneous nephrostomy. Recurrence developed in the upper urinary tract in 31 patients (3%) at a median of 17 months after cystectomy, including 7 of 53 (13%) in the Double-J group, 0% in the nephrostomy group and 24 of 891 (3%) in the no drainage group. Multivariate regression analysis revealed a higher risk of upper urinary tract recurrence if patients underwent Double-J stenting (HR 4.54, 95% CI 1.43-14.38, p = 0.01) and preoperative intravesical instillations (HR 2.94, 95% CI 1.40-6.16, p = 0.004). CONCLUSIONS Patients who undergo Double-J stenting prior to radical cystectomy are at higher risk for upper urinary tract recurrence. If preoperative upper urinary tract drainage is required, percutaneous drainage might be recommended.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Kiss, Bernhard; Furrer, Marc; Wüthrich, Patrick Yves; Burkhard, Fiona C.; Thalmann, George and Roth, Beat

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1527-3792

Publisher:

Elsevier

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

13 Nov 2017 16:04

Last Modified:

23 Jan 2018 12:13

Publisher DOI:

10.1016/j.juro.2017.06.020

PubMed ID:

28603003

Uncontrolled Keywords:

cystectomy local neoplasm recurrence nephrostomy percutaneous stents urinary bladder neoplasms

BORIS DOI:

10.7892/boris.106101

URI:

https://boris.unibe.ch/id/eprint/106101

Actions (login required)

Edit item Edit item
Provide Feedback