title: Early repeated ureteroscopy within 6-8 weeks after a primary endoscopic treatment in patients with upper tract urothelial cell carcinoma: preliminary findings.
abstract: OBJECTIVE
  To evaluate the cancer detection rate (CDR) of an early repeated flexible ureteroscopy (2nd-look-URS) and its impact on the conservative management of patients affected with upper urinary tract urothelial carcinoma (UTUC).
  
  
  METHODS
  Clinical and surgical data from 41 patients with UTUC who underwent 2nd-look-URS within 60 days of their first URS with concomitant laser tumour photoablation at a single tertiary care referral centre from 2009 to 2013 were retrospectively analyzed. Radical nephroureterectomy was offered during follow-up in case of massive tumour recurrence (defined as a tumour not completely removable only with a conservative approach). Descriptive statistics tested the impact of 2nd-look-URS outcomes on subsequent endoscopic evaluation. Kaplan-Meier curves assessed massive tumour recurrence-free survival (mRFS) rates according to the presence of a tumour at 2nd-look-URS. Cox regression analyses identified predictors of mRFS.
  
  
  RESULTS
  CDR at 2nd-look-URS was 51.2 %. CDRs at third URS were 81.3 and 41.2 % in patients with a positive and a negative 2nd-look-URS, respectively (p = 0.02). At a mean (median) follow-up of 34.6 (27.6) months, mRFS rates were 88 and 48 % in patients with negative and positive 2nd-look-URS, respectively (log rank = 0.015). Tumour grade at first URS and 2nd-look-URS outcomes achieved predictor status for mRFS (HR 6.1, 95 % CI 1.42-26.27 and HR 5.39, 95 % CI 1.18-24.66, respectively, all p ≤ 0.03).
  
  
  CONCLUSIONS
  2nd-look-URS-related CDR in conservatively treated UTUC patients was 51.2 %. 2nd-look-URS outcomes affected the findings of both subsequent endoscopic evaluation and mRFS. Further studies are needed to confirm the benefits of this approach in terms of patient outcomes.
authors.affiliation: Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France.|Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Villa
authors.affiliation: Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cloutier
authors.affiliation: Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Letendre
authors.affiliation: Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France.
authors.forename: Achilles
authors.initials: A
authors.lastname: Ploumidis
authors.affiliation: Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Cornu
authors.affiliation: Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.|Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, 75970, Paris Cedex 20, France. olivier.traxer@tnn.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014516:Ureteral Neoplasms / Q000601:surgery*; D018666:Ureteroscopy; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000601:surgery*
keywords: Conservative treatment; Flexible ureteroscopy; Second look; Upper urinary tract urothelial carcinoma