title: Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma.
abstract: BACKGROUND
  There is a lack of consensus regarding the prognostic significance of different approaches to the bladder cuff at surgery for primary upper urinary tract urothelial carcinoma (UUT-UC).
  
  
  OBJECTIVE
  To compare the oncologic outcomes following radical nephroureterectomy using three different methods of managing the bladder cuff.
  
  
  METHODS
  From January 1990 to December 2007, 414 patients with primary UUT-UC underwent radical nephroureterectomy at our institution. Of these, 301 were included in our study.
  
  
  METHODS
  Three methods of bladder cuff excision-intravesical incision, extravesical incision, and transurethral incision (TUI)-were performed.
  
  
  METHODS
  Patients' medical records were reviewed retrospectively. The clinicopathologic data and oncologic outcomes were compared among groups.
  
  
  CONCLUSIONS
  Of the 301 patients, 81 (26.9%) underwent the intravesical method, 129 (42.9%) underwent the extravesical technique, and 91 (30.2%) underwent TUI. There were no differences in clinical and histopathologic data among the three groups. When comparing the intravesical, extravesical, and TUI techniques, bladder recurrence developed in, respectively, 23.5%, 24.0%, and 17.6% cases (p=0.485); local retroperitoneal recurrence in 7.4%, 7.8%, and 5.5% (p=0.798); contralateral recurrence in 4.9%, 3.9%, and 2.2% (p=0.632); and distant metastasis in 7.4%, 10.4%, and 5.5% (p=0.564). There were no differences in recurrence-free and cancer-specific survival among the three groups (p=0.680 and 0.502, respectively).
  
  
  CONCLUSIONS
  The three techniques had comparable oncologic outcomes. Our data validate the TUI method of bladder cuff control in patients with primary UUT-UC without coexistent bladder tumors.
authors.affiliation: Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Li
authors.forename: Jung-Tsung
authors.initials: JT
authors.lastname: Shen
authors.forename: Ching-Chia
authors.initials: CC
authors.lastname: Li
authors.forename: Hung-Lung
authors.initials: HL
authors.lastname: Ke
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Wei
authors.forename: Wen-Jeng
authors.initials: WJ
authors.lastname: Wu
authors.forename: Yii-Her
authors.initials: YH
authors.lastname: Chou
authors.forename: Chun-Hsiung
authors.initials: CH
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000556:secondary*; D013520:Urologic Surgical Procedures / Q000379:methods*; D019459:Urothelium / Q000473:pathology; D055815:Young Adult