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Stenting prior to cystectomy predicts upper urinary tract recurrence

17 Nov 2017

An increased risk for upper urinary tract recurrence is present in patients undergoing double-J stenting prior to radical cystectomy, suggests a recent study.

The authors retrospectively analysed the records of consecutive patients (n=1,005) with bladder cancer who underwent radical cystectomy between January 2000 and June 2016 to determine whether these patients are at higher risk for upper urinary tract recurrence if retrograde stenting has been conducted before radical cystectomy.

To be included in the study, negative intraoperative ureteral margins were required. Patients received regular follow-up according to institutional protocol, which included imaging of the upper urinary tract and urine cytology.

Of the patients, 114 (11 percent) had preoperative drainage of the upper urinary tract, including 53 (46 percent) by double-J stenting and 62 (54 percent) by percutaneous nephrostomy. At a median of 17 months after cystectomy, 31 patients (3 percent) developed recurrence in the upper urinary tract, including seven of 53 (13 percent) in the double-J group, none in the nephrostomy group and 24 of 891 (3 percent) in the no-drainage group.

The risk of upper urinary tract recurrence was higher if patients underwent double-J stenting (hazard ratio [HR], 4.54; 95 percent CI, 1.43 to 14.38; p=0.01) and preoperative intravesical instillation (HR, 2.94; 1.40 to 6.16; p=0.004) based on multivariate regression analysis.

“If preoperative upper urinary tract drainage is required, percutaneous drainage might be recommended,” according to researchers.

“Patients with bladder cancer who present with hydronephrosis may require drainage of the affected kidney before receiving further cancer treatment. Drainage can be done by retrograde stenting or percutaneously. However, retrograde stenting carries the risk of tumour cell spillage to the upper urinary tract,” they noted.

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