title: Resection of the Intramural Portion of the Distal Ureter during Transurethral Resection of Bladder Tumors: Predictive Factors for Secondary Stenosis and Development of Upper Urinary Tract Recurrence.
abstract: We analyzed the incidence of and predictive factors for ureteral stenosis and recurrent upper urinary tract urothelial carcinoma after resection of tumors located in the intramural portion of the distal ureter.
  
  
  
  We retrospectively analyzed the records of 2,317 patients who underwent transurethral resection of bladder tumor for nonmuscle invasive bladder cancer, including 112 (4.83%) with tumors involving the intramural portion of the distal ureter. Multivariate Cox regression analysis was done to determine predictive factors for ureteral stenosis and recurrent urinary tract urothelial carcinoma.
  
  
  
  At a mean followup of 56 months 17 patients (15.2%) presented with recurrent upper urinary tract urothelial carcinoma and ureteral stenosis had developed in 13 (11.6%). On univariate analysis previous recurrences were associated with both events. On multivariate analysis tumor size 1.5 cm or greater (HR 4.521, p = 0.023) and T1 tumor stage (HR 8.525, p = 0.005) were independent predictive factors for stenosis. Stage T1 in the bladder (HR 7.253, p = 0.001) and carcinoma in situ in the intramural portion of the distal ureter (HR 6.850, p = 0.005) increased the risk of recurrent upper urinary tract urothelial carcinoma. The main study limitation was the lack of information on vesicoureteral reflux due to the retrospective design.
  
  
  
  Involvement of the intramural portion of the distal ureter is uncommon. In patients with nonmuscle invasive bladder cancer and involvement of the intramural portion of the distal ureter a stage T1 tumor and a tumor size 1.5 cm or greater are independent predictive factors for distal ureteral stenosis. Moreover, stage T1 and carcinoma in situ in the intramural portion of the distal ureter significantly increase the risk of recurrent upper urinary tract urothelial carcinoma. The urinary tract should be more closely followed in this patient subgroup.
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain. Electronic address: orodriguez@fundacio-puigvert.es.
authors.forename: Oscar
authors.initials: O
authors.lastname: Rodriguez Faba
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Gaya
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Breda
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Juarez Del Dago
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pisano
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Salas
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Palou
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: carcinoma; constriction, pathologic; recurrence; ureter; urinary bladder neoplasms