title: Predictors, pathological characteristics and outcomes of bladder recurrences following nephroureterectomy.
abstract: OBJECTIVE
  To analyze the predictors for bladder recurrence (BR) after nephroureterectomy (NU) for upper urinary tract tumors (UUTT), as well as its pathological characteristics, outcomes and impact on survival.
  
  
  METHODS
  Retrospective study of 117 patients who underwent laparoscopic nephroureterectomy by UUTT between 2007-2012 at our center. The potential predictors for BR were analyzed using Cox regression; Kaplan-Meier curves were employed to study survival.
  
  
  RESULTS
  The sample was composed of 85 men (73%) and 32 women (27%), with a mean age of 70 years. After a mean follow-up of 26 months, 23 patients presented BR (19.6%). In the multivariate analysis, sex (p=.003; HR [female], 3.8) and the location of the UUTT in the distal ureter (p=.002; HR, 4.8) were independent predictors for BR. The median time to BR was 8 months. Fifteen patients presented a nonmuscle-invasive BR (65.2%), and 8 presented a muscle-invasive BR (34.8%). All BRs, except for 2, appeared during the first 2 years. Five cases with nonmuscle-invasive BR presented a new BR. Six patients with muscle-invasive BR died before it could be determined whether cause of death was the BR or an UUTT relapse. The onset of BR showed no repercussion on the survival of patients with UUTT.
  
  
  CONCLUSIONS
  Sex (female) and the location of the UUTT (distal ureter) are predictors for BR after NU. Patients with these characteristics might benefit from adjuvant intravesical treatment and closer monitoring. The onset for RV has no impact on the survival of patients with UUTT.
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España. Electronic address: lmateuarrom@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Mateu
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Huguet
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Carrión
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: García-Cruz
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: L
authors.initials: L
authors.lastname: Izquierdo
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Musquera
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ribal
authors.affiliation: Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Alcaraz
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology*; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Bladder recurrence; Nefroureterectomía; Nephroureterectomy; Recidiva vesical; Tumor urotelial de tracto urinario superior; Upper urinary tract urothelial tumor