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05.09.2023 | Original Article

The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma

verfasst von: Andrea Gallioli, Giuseppe Basile, Angelo Territo, Paolo Verri, Josep Maria Gaya, Francesco Sanguedolce, Julia Aumatell, Paula Izquierdo, Alessandro Uleri, Pietro Diana, Jorge Huguet, Ferran Algaba, Joan Palou, Alberto Breda

Erschienen in: World Journal of Urology | Ausgabe 10/2023

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Abstract

Purpose

The purpose of the study was to evaluate the effect of second-look ureteroscopy (SU) in the endoscopic operative work-up of patients with upper tract urothelial carcinoma (UTUC).

Materials and methods

Patients with UTUC who underwent SU between 2016 and 2021 were included. Cancer detection rate (CDR) at SU was defined as endoscopic visualization of tumor. The effect of SU on recurrence-free survival (RFS), radical nephroureterectomy-free survival (RNU-FS), bladder cancer-free survival (BC-FS), and cancer-specific survival (CSS) was estimated using the Kaplan–Meier method. Multivariate logistic regression analysis (MLR) assessed predictors of negative SU. Finally, we evaluated the effect of SU timing on oncological outcomes, classifying SUs as “early” (≤ 8 weeks) and “late” (> 8 weeks).

Results

Overall, 85 patients underwent SU. The CDR at SU was 44.7%. After a median follow-up was 35 (IQR: 15–56) months, patients with positive SU had a higher rate of UTUC recurrence (47.4% vs 19.1%, p = 0.01) and were more frequently radically treated (34.2% vs 8.5%, p = 0.007). Patients with high-grade disease (hazard ratio [HR]: 3.14, 95% CI 1.18–8.31; p = 0.02) had a higher risk of UTUC recurrence, while high-grade tumor (HR: 3.87, 95%CI 1.08–13.77; p = 0.04) and positive SU (HR: 4.56, 95%CI 1.05–22.81; p = 0.04) were both predictors of RNU. Low-grade tumors [odds ratio (OR): 5.26, 95%CI 1.81–17.07, p = 0.003] and tumor dimension < 20 mm (OR: 5.69, 95%CI 1.48–28.31, p = 0.01) were predictors of negative SU. Finally, no significant difference emerged regarding UTUC recurrence, RNU, BC-FS, and CSM between early vs. late SUs (all p > 0.05).

Conclusions

SU may help in identifying patients with UTUC experiencing an early recurrence after conservative treatment. Patients with low-grade and small tumors are those in which SU could be safely postponed after 8 weeks.

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Titel: The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma
verfasst von: Andrea Gallioli
Giuseppe Basile
Angelo Territo
Paolo Verri
Josep Maria Gaya
Francesco Sanguedolce
Julia Aumatell
Paula Izquierdo
Alessandro Uleri
Pietro Diana
Jorge Huguet
Ferran Algaba
Joan Palou
Alberto Breda
Publikationsdatum: 05.09.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 10/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04577-8

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The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma