URETERAL STENT PLACEMENT VS NEPHROSTOMY TUBE PLACEMENT PRIOR TO RADICAL CYSTECTOMY DOES NOT INCREASE POST-CYSTECTOMY UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP82)1 Apr 2020MP82-20 URETERAL STENT PLACEMENT VS NEPHROSTOMY TUBE PLACEMENT PRIOR TO RADICAL CYSTECTOMY DOES NOT INCREASE POST-CYSTECTOMY UPPER TRACT UROTHELIAL CARCINOMA Vidit Sharma*, Tanner Miest, Luca Boeri, Prabin Thapa, Matthew K. Tollefson, R. Houston Thompson, Stephen A. Boorjian, Igor Frank, and R. Jeffrey Karnes Vidit Sharma*Vidit Sharma* More articles by this author , Tanner MiestTanner Miest More articles by this author , Luca BoeriLuca Boeri More articles by this author , Prabin ThapaPrabin Thapa More articles by this author , Matthew K. TollefsonMatthew K. Tollefson More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Igor FrankIgor Frank More articles by this author , and R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000974.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hydronephrosis prior to radical cystectomy (RC) for urothelial carcinoma is variably treated with observation, ureteral stent, or percutaneous nephrostomy tube (PNT). A single study found that ureteral stent drainage was associated with a higher rate of upper tract urothelial carcinoma (UTUC) after RC compared to PNT. However, more studies are needed to corroborate these findings before a guideline statement is formulated. METHODS: We identified patients undergoing RC for urothelial carcinoma (without prior UTUC) at our institution from 2000-2015. Pre-operative hydronephrosis and upper tract drainage were assessed. The cohort of 1049 RCs was stratified into four groups: 1) no hydronephrosis (75%, N=787); 2) hydronephrosis without upper tract drainage (13%, N=132); 3) hydronephrosis with PNT (3%, N=36); 4) hydronephrosis treated with ureteral stent (9%, N=94). The risk of UTUC post-cystectomy and post-operative complications was compared using Kaplan-Meier analyses and multivariable regression modeling. RESULTS: In a cohort of 1049 RCs (median follow up for survivors of 4.3 years), the 5-year post-RC UTUC rate was 6.6%, 10.2%, 17%, 18.7% for groups 1-4, respectively (p=0.127). After adjusting for age, comorbidities, pT stage, pN stage, neoadjuvant chemotherapy, LVI, margins, and year, multivariable Cox proportional hazard modeling found that relative to patients without pre-operative hydronephrosis, patients with hydronephrosis without upper tract drainage (hazard ratio (HR) 1.31, 1.08-1.58, p=0.01) and hydronephrosis with PNT (HR 1.49, 1.06-2.09, p=0.02) had higher post-RC UTUC rates. Patients with hydronephrosis and a ureteral stent did not have higher post-RC UTUC rates relative to patients without hydronephrosis (HR 0.90, 0.72-1.12, p=0.33). The incidence of ureteroenteric anastomotic stricture/leaks (8.5%, 9.2%, 8.3%, 10.6%, respectively, p=0.918) and pyelonephritis (14.5%, 14.4%, 8.3%, 14.9%, respectively, p=0.778) did not differ between groups. CONCLUSIONS: Pre-RC hydronephrosis was confirmed to be a risk factor for UTUC after RC. Adjusting for hydronephrosis, ureteral stent placement did not negatively impact the incidence of UTUC, ureteroenteric anastomotic complications or upper tract urinary infections. The higher rate of UTUC seen with PNT likely reflects the higher degree of obstruction from the primary tumor and other unmeasured confounders. Our data does not support the preferential use of PNT over ureteral stents for hydronephrosis prior to RC. Source of Funding: N/a © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1254-e1254 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vidit Sharma* More articles by this author Tanner Miest More articles by this author Luca Boeri More articles by this author Prabin Thapa More articles by this author Matthew K. Tollefson More articles by this author R. Houston Thompson More articles by this author Stephen A. Boorjian More articles by this author Igor Frank More articles by this author R. Jeffrey Karnes More articles by this author Expand All Advertisement PDF downloadLoading ...