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

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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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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

NSS:

Nephron-sparing surgery

SU:

Second-look ureteroscopy

UTUC:

Upper tract urothelial carcinoma

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Author notes

  1. Andrea Gallioli and Giuseppe Basile equally contributed to the study.

Authors and Affiliations

  1. Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain

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

  2. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy

    Giuseppe Basile

  3. Department of Urology, University of Turin, Turin, Italy

    Paolo Verri

  4. Department of Urology, Humanitas University, Rozzano, Milan, Italy

    Alessandro Uleri & Pietro Diana

  5. Department of Pathology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain

    Ferran Algaba

Authors
  1. Andrea Gallioli
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  2. Giuseppe Basile
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Contributions

AG, GB, AT, PV, JMG, FS, JA, PI, AU, PD, JH, FA, JP, and AB helped in protocol/project development. AG and GB helped in data collection or management. GB helped in data analysis. GB, AG, and AB contributed to manuscript writing/editing.

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Correspondence to Giuseppe Basile.

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Gallioli, A., Basile, G., Territo, A. et al. The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma. World J Urol 41, 2743–2749 (2023). https://doi.org/10.1007/s00345-023-04577-8

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  • DOI: https://doi.org/10.1007/s00345-023-04577-8

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