Bladder Chemoprophylaxis Following Ureterorenoscopy in Patients with Upper Tract Urothelial Carcinoma

Ferraris, F; Raman, Jay D.; Yaber, F

doi:10.1016/j.euf.2021.07.007

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…Although we demonstrated that URS prior to RNU is associated with significantly worse IVRFS than RNU alone in patients not receiving immediate intravesical installation following RNU, we were unable to perform subgroup analyses for the subset of patients who received adjuvant intravesical treatment due to a paucity of data. Moreover, there is currently an intense discussion over whether or not bladder chemoprophylaxis should be administered immediately after URS for the diagnosis or treatment of UTUC [39]. At present, there are no recommendations for such a procedure, with only indirect data available.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Nowak

Krajewski

Chorbińska

et al. 2021

JCM

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Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU. However, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes. Materials and methods: A systematic literature search of the PubMed, Embase, and Cochrane Library databases was performed in June 2021. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS). Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR = 1.44, 95% CI: 1.29–1.61, p < 0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR = 1.28, 95% CI: 0.90–1.80, p = 0.16). The results of other analyses showed no significant differences in CSS (HR = 0.94, p = 0.63), OS (HR: 0.94, p = 0.56), and MFS (HR: 0.91, p = 0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC.

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Section: Discussionmentioning

confidence: 99%

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Nowak

Krajewski

Chorbińska

et al. 2021

JCM

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“…Finally, a randomised comparison between a URS-Bx-based diagnostic pathway and a straight-to-RNU approach would raise numerous ethical and clinical issues; instead, a high-quality trial on immediate post-URS-Bx chemoprophylaxis, considering also a risk-based post-RNU cystoscopy surveillance, is eagerly awaited. 9,10…”

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confidence: 99%

Ureteroscopic biopsy for upper tract urothelial cancers: A valuable double-edged tool in the era of a risk-stratified approach

Rouprêt

Calleris

2022

Scott Med J

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Bladder Chemoprophylaxis Following Ureterorenoscopy in Patients with Upper Tract Urothelial Carcinoma

Cited by 2 publications

References 12 publications

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Ureteroscopic biopsy for upper tract urothelial cancers: A valuable double-edged tool in the era of a risk-stratified approach

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