title: Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma.
abstract: BACKGROUND
  Little is known about the effects of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy.
  
  
  METHODS
  This study was designed to determine the effect of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy. From 2004 to 2010, 446 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical center. We included 115 patients who underwent preoperative diagnostic ureteroscopy and 281 patients who did not. This study analyzed the impact of the reported risk factors and diagnostic ureteroscopy for intravesical recurrence after nephroureterectomy by multivariate Cox regression model.
  
  
  RESULTS
  The rates of metastasis and cancer-specific mortality did not differ significantly between the two groups. Diagnostic ureteroscopy was associated with a higher incidence of intravesical recurrence in patients with (p=0.02) and without (p=0.016) a previous history of bladder cancer. Ureter tumor biopsy (p=0.272) and ureter involvement (p=0.743) were not associated with the rate of intravesical recurrence in this study. Multivariate Cox regression analysis showed that only bladder cancer history (p<0.001), multifocal tumor (p=0.05), and diagnostic ureteroscopy (p=0.05) were independently associated with intravesical recurrence.
  
  
  CONCLUSIONS
  Diagnostic ureteroscopy for upper urinary tract cancer was not associated with metastasis and cancer-specific mortality. However, ureteroscopy was associated with an increased incidence of intravesical tumor recurrence. Methods of prevention should be considered to decrease intravesical recurrence and avoid repeated surgical interventions or the development of advanced bladder disease in patients at risk.
authors: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Hao Lun
authors: HL
authors: Luo
authors: Chih Hsiung
authors: CH
authors: Kang
authors: Yen Ta
authors: YT
authors: Chen
authors: Yao Chi
authors: YC
authors: Chuang
authors: Wei Ching
authors: WC
authors: Lee
authors: Yuan Tso
authors: YT
authors: Cheng
authors: Po Hui
authors: PH
authors: Chiang
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy; D013520:Urologic Surgical Procedures