Diagnostic outcome of ureteroscopy in urothelial carcinoma of the upper urinary tract: Incidence of later cancer detection and its risk factors after the first examination.

ABSTRACT

BACKGROUND: To determine the incidence of later cancer detection and its risk factors after the first diagnostic ureteroscopy. METHODS: One hundred and sixty-six patients undergoing diagnostic ureteroscopy based on the suspicion of urothelial carcinoma of the upper urinary tract (UC of the UUT) between 1995 and 2012 were included. We examined the diagnostic outcome of the initial ureteroscopy. Thereafter, we collected follow-up data on patients who had not been diagnosed with UC of the UUT at the first examination, and evaluated the incidence of later cancer detection and its risk factors using Cox hazard models. RESULTS: Of the 166 patients, 76 (45.8%) were diagnosed with UC of the UUT at the first diagnostic ureteroscopy. The remaining 90 (54.2%) were diagnosed with other malignancies (n = 22), non-malignant disorders (n = 18), or without disorders (n = 50). Of these 90 patients, follow-up data were available in 65 patients (median 41 months, range 3-170). During the follow-up, carcinoma was detected in 6 patients (6/65, 9.2%) at a median of 43.5 months (range 10-59). Episodes of gross hematuria (p = 0.0048) and abnormal cytological findings (p = 0.0335) during the follow-up and a male sex (p = 0.0316) were adverse risk factors. CONCLUSION: Later cancer detection of UC of the UUT was not uncommon after the first examination. The risk analysis revealed the aforementioned characteristics.