title: Correlation Between the Timing of Diagnostic Ureteroscopy and Intravesical Recurrence in Upper Tract Urothelial Cancer.
abstract: To identify the effects of diagnostic ureteroscopy on intravesical recurrence, 104 patients who had undergone radical nephroureterectomy were analyzed. The number of patients with intravesical recurrence was 34 (32.6%) at a mean of 37 months. Multivariate Cox model analysis revealed that delayed nephroureterectomy after diagnostic ureteroscopy were independent predictive factors for intravesical recurrence.
  
  
  BACKGROUND
  The purpose of this study was to evaluate the effects of the timing of diagnostic ureteroscopy (URS) relative to radical nephroureterectomy (RNU) on intravesical recurrence (IVR).
  
  
  METHODS
  We retrospectively evaluated 104 patients who had undergone RNU for upper tract urothelial cancer (UTUC) at a single tertiary referral center between March 2003 and December 2012. All patients were divided depending on the timing of diagnostic URS: the no URS group (30 patients, no URS), 1-session group (33 patients, diagnostic URS immediately followed by RNU), and 2-session group (41 patients, RNU after diagnostic URS at a median time of 5 days). We analyzed for IVR-free survival using the Kaplan-Meier and Cox proportional regression methods.
  
  
  RESULTS
  Of the 104 patients, 34 (32.6%) developed subsequent IVR at a mean interval of 7.2 months. The Kaplan-Meier curve showed that the IVR rate was significantly greater in the 2-session group than in the other groups (P = .004). Univariate analysis indicated no effect on IVR in the 1-session group compared with the no URS group (hazard ratio [HR], 95% confidence interval [CI] 1.58; 0.517-4.833). However, the 2-session group had a significantly greater number of patients with IVR than the no URS group (HR, 3.82; 95% CI 1.438-10.131). Multivariate Cox proportional analysis revealed that the 2-session group was an independent predictor of IVR in UTUC patients (HR, 3.61; 95% CI 1.039-12.557).
  
  
  CONCLUSIONS
  Delay of RNU after diagnostic URS significantly increased the risk of IVR in UTUC patients.
authors.affiliation: Department of Urology, Seoul National University of Hospital, Seoul, Republic of Korea.
authors.forename: Jung Keun
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Ki Bom
authors.initials: KB
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul St Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Oh
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Sangchul
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Electronic address: 38jklee@gmail.com.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018666:Ureteroscopy; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology*
keywords: Diagnosis; Intravesical recurrence; Nephroureterectomy​; Upper tract urothelial cancer; Ureteroscopy