title: Diagnostic Ureteroscopy for Upper Tract Urothelial Carcinoma is Independently Associated with Intravesical Recurrence after Radical Nephroureterectomy.
abstract: OBJECTIVE
  To determine the effect of diagnostic ureteroscopy on intravesical recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterec¬tomy (RNU).
  
  
  METHODS
  We conducted a retrospective analysis of 664 patients who were treated with RNU for UTUC from June 2000 to December 2011, excluding those who had concomitant/prior bladder tumors. Of the 664 patients, 81 underwent di¬agnostic ureteroscopy (URS). We analyzed the impact of diagnostic ureteroscopy on intravesical recurrence (IVR) using the Kaplan-Meier method. Univariate and multi¬variate analyses were used to determine the independent risk factors.
  
  
  RESULTS
  The median follow-up time was 48 months (interquartile range (IQR): 31- 77 months). Patients who underwent ureteroscopy were more likely to have a small (p<0.01), early-staged (p=0.019), multifocality (p=0.035) and ureteral tumor (p<0.001). IVR occurred in 223 patients during follow-up within a median of 17 months (IQR: 7-33). Patients without preoperative ureteroscopy have a statistically significant better 2-year (79.3%±0.02 versus 71.4%±0.02, p<0.001) and 5-year intravesical recurrence-free survival rates (64.9%±0.05 versus 44.3%±0.06, p<0.001) than patients who un¬derwent ureteroscopy. In multivariate analysis, the diagnostic ureteroscopy (p=0.006), multiple tumors (p=0.001), tumor size <3cm (p=0.008), low-grade (p=0.022) and pN0 stage tumor (p=0.045) were independent predictors of IVR.
  
  
  CONCLUSIONS
  Diagnostic ureteroscopy is independently associated with intravesical re¬currence after radical nephroureterectomy.
authors: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
authors: Pei
authors: P
authors: Liu
authors: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
authors: Xiao-Hong
authors: XH
authors: Su
authors: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
authors: Geng-Yan
authors: GY
authors: Xiong
authors: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
authors: Xue-Song
authors: XS
authors: Li
authors: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
authors: Li-Qun
authors: LQ
authors: Zhou
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000556:secondary / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods*; D014513:Ureter / Q000473:pathology; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Bladder; Oncology; Ureteroscopy