Assessment of association between lower ureteric excision technique and oncological outcomes for upper urinary tract urothelial carcinoma: retrospective analysis from the Scottish Renal Cancer Consortium.

PURPOSE: Nephroureterectomy(NU) remains the gold-standard surgical option for the management of upper urinary tract urothelial carcinoma(UTUC). Controversy exists regarding the optimal excision technique of the lower ureter. We sought to compare post-UTUC bladder tumour recurrence across the Scottish Renal Cancer Consortium(SRCC). METHODS: Patients who underwent NU for UTUC across the SRCC 2012-2019 were identified. The impact of lower-end surgical technique along with T-stage, N-stage, tumour location and focality, positive surgical margin, pre-NU ureteroscopy, upper-end technique and adjuvant mitomycin C administration were assessed by Kaplan-Meier and Cox-regression. The primary outcome was intra-vesical recurrence-free survival (B-RFS). RESULTS: In 402 patients, the median follow-up was 29 months. The lower ureter was managed by open transvesical excision in 90 individuals, transurethral and laparoscopic dissection in 76, laparoscopic or open extra-vesical excision in 31 and 42 respectively, and transurethral dissection and pluck in 163. 114(28.4%) patients had a bladder recurrence during follow-up. There was no difference in B-RFS between lower-end techniques by Kaplan-Meier (p = 0.94). When all factors were taken into account by adjusted Cox-regression, preceding ureteroscopy (HR 2.65, p = 0.001), lower ureteric tumour location (HR 2.16, p = 0.02), previous bladder cancer (HR 1.75, p = 0.01) and male gender (HR 1.61, p = 0.03) were associated with B-RFS. CONCLUSION: These data suggest in appropriately selected patients, lower ureteric management technique does not affect B-RFS. Along with lower ureteric tumour location, male gender and previous bladder cancer, preceding ureteroscopy was associated with a higher recurrence rate following NU, and the indication for this should be carefully considered.

Epidemiology of hepatitis C virus infection in Pakistan.

Since the discovery of hepatitis C virus (HCV) in 1989 as the causative agent of post-transfusion non-A non-B hepatitis, the epidemiology, pattern of transmission, different genotypes and clinical consequences of the disease have been studied worldwide, but little is known about the epidemiology of HCV infection in Pakistan. This paper reviews the available evidence on the epidemiology of HCV infection in Pakistan obtained via MEDLINE search (1970-2005) of published articles with key words hepatitis C and Pakistan, and other sources including ongoing discussions within the medical community. Approximately 10 million people have been infected with HCV in Pakistan. The majority of patients have acquired their infection through unsafe injections, reuse of syringes and needles and community barber shops used for face and armpit shaving. More than two-thirds of HCV patients were 40 to 50 years old. Although at present a small proportion of those with chronic HCV infection develop liver failure or hepatocellular carcinoma, it is estimated that the incidence of these advanced disease complications will increase over the coming years.