診斷性輸尿管鏡對於上泌尿道泌尿上皮癌術後膀胱復發之影響
盧則宏、歐建慧
國立成功大學醫學院附設醫院泌尿部
Intravesical recurrence rate of diagnostic ureteroscopy prior to nephroureterectomy for upper tract urothelial carcinoma
Ze-Hong Lu、Chien-Hui Ou
Department of Urology, National Cheng Kung University Hospital, College of
Medicine, National Cheng Kung University, Tainan, Taiwan
Purpose:
In Taiwan, the prevalence rate of upper tract urothelial carcinoma(UTUC) is high. The most powerful diagnostic tool for UTUC is diagnostic ureteroscopy(URS) with or without biopsy. However, it is a challenge to perform semi-rigid URS for renal pelvis lesion. Besides, in end stage renal disease patients, ureter may be too narrow to perform URS and it may bring unnecessary complications. The aim of this study to analyze the effect of diagnostic ureteroscopy prior to radical nephroureterectomy(NUR) for upper tract urothelial carcinomas.
Materials and Methods:
We retrospectively review the cases who receive NUR during November 2003 to November 2013 at single medical center in south Taiwan. Only patients receiving NUR for UTUC are included. Other surgical indication such as infection, trauma or urolithiasis are all excluded. All medical record are reviewed including characteristic, intravesical recurrence rate, and oncologic results.
Results:
267 patients were included with 103 males and 164 females. The mean age was 66.77 year-old. The mean BMI was 25.19. The most common initial presentation was gross hematuria. Up to 30% patients(n=80) received URS with or without biopsy prior to NUR. Of those 80 patients, 25 patients(31%) had intravesical recurrence. The other 187 patients did not receive diagnostic URS prior to NUR, and 62 patients(33%) of them had intravesical recurrence. After excluding patients with concomitant bladder cancer history, we divided patients into URS and No URS group. 62 patients were included in URS group, and 138 patients were in No URS group. Intravesical recurrence rate of URS group was 21%(n=13), and 42 patients (30%) of No URS group had intravesical recurrence
Conclusions:
In south Taiwan, and prevalence rate of UTUC, bladder urothelial carcinoma and chronic kidney disease(CKD) is high. According to EAU guideline, diagnostic URS and biopsy only be considered in that the result will change the choice of treatment. Besides, it had been established the relationship between diagnostic URS and intravesical recurrence from previous studies. However, from our data, it did not reveal similar results. It may be related to study limitations. First, it is relatively small samples size in URS group. Secondly, bladder cancer and CKD prevalence rate is high in south Taiwan. Besides, we do not have any specific protocol for whether patient receiving URS or not. The patients with nonfunctional kidney or end stage renal status may receive NUR without URS, and those dialysis patients have higher risk of bladder cancer.