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Tristan Manalac, 16 Feb 2018
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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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Most Read Articles
2 days ago
There appears to be a high rate of emergency department (ED) admission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), with patients having significant in-hospital mortality, according to data from the *AANZDEM study. Furthermore, compliance with evidence-based treatments in the ED is suboptimal.
Tristan Manalac, 6 days ago
Of the newly identified genetic loci for primary angle-closure glaucoma (PACG), two are significantly associated with primary angle-closure suspect (PACS), indicating involvement in the earlier stages of the disease, a recent Singapore study has shown.
Pearl Toh, 3 days ago
Patients with inflammatory bowel disease (IBD) who had primary nonresponse to an anti-tumour necrosis factor (TNF) agent ─ or inadequate response to the initial loading doses ─ were less likely to respond to second-line biologics compared with those who had secondary loss of response (LOR) or intolerance to the primary therapy, according to a systematic review and meta-analysis presented at the Crohn's & Colitis Congress (CCC) 2018 held recently in Las Vegas, Nevada, US.
Tristan Manalac, 16 Feb 2018
Placebo pills, even when administered open-label, appear to significantly improve cancer-related fatigue and fatigue-disrupted quality of life, according to a recent study.