ABSTRACT
PURPOSE: The incidence and risk factors for metachronous upper tract urothelial carcinoma (UTUC) following radical cystectomy (RC) remain incompletely defined, which has limited the ability to individualize postoperative surveillance. MATERIALS AND METHODS: A retrospective review of 2 institutional registries was performed to identify patients undergoing RC for urothelial carcinoma. Multivariable Cox proportional hazard models for metachronous post-RC UTUC were developed in one institutional data set and validated in the second institutional data set. A post-RC UTUC risk score was then developed from these models. RESULTS: A total of 3,170 RC patients were included from the training cohort and 959 RC patients from the validation cohort. At a median followup after RC of 4.6 years (IQR 2.1-8.7), 167 patients were diagnosed with UTUC. On multivariable analysis in the training cohort, risk factors for metachronous UTUC were the presence of positive urothelial margin (HR 2.60, p <0.01), history of bacillus Calmette-Guérin treatment prior to RC (HR 2.20, p <0.01), carcinoma in situ at RC (HR 2.01, p <0.01) and pre-RC hydronephrosis (HR 1.48, p=0.04). These factors had similar discriminative capacity in the training and validation cohorts (C-statistic 0.71 and 0.73, respectively). A UTUC risk score was developed with these variables which stratified patients into low (0 points), intermediate (1-3 points), and high risk (4+ points) for post-RC UTUC, with respective 5-year UTUC-free survivals of 99%, 96%, 89% in the training cohort and 98%, 96%, and 91% in the validation cohort. CONCLUSIONS: We developed and validated a risk score for post-RC UTUC that may optimize UTUC surveillance protocols after RC.
Subject(s)
Carcinoma, Transitional Cell/epidemiology , Kidney Neoplasms/epidemiology , Neoplasms, Second Primary/epidemiology , Ureteral Neoplasms/epidemiology , Urinary Bladder Neoplasms/therapy , Aged , Carcinoma, Transitional Cell/therapy , Cystectomy , Female , Follow-Up Studies , Humans , Incidence , Kidney Neoplasms/diagnosis , Male , Middle Aged , Neoadjuvant Therapy , Neoplasms, Second Primary/diagnosis , Postoperative Period , Registries/statistics & numerical data , Retrospective Studies , Risk Assessment/methods , Risk Factors , Ureteral Neoplasms/diagnosis , Ureteroscopy/statistics & numerical data , Urinary Bladder Neoplasms/pathologyABSTRACT
Malignant ureteral obstruction is a morbid diagnosis and can be difficult to manage. Ureteral stents often fail as the disease progresses. Metallic stents have provided a longer-term option for decompression as they inherently resist compression and require changes left often. However, changing metallic stents is challenging as it cannot be done over a wire as is done with plastic stents. We present a novel technique for safe and efficient exchange of the Resonance(®) metallic stent. We also review the literature on metallic stents.
Subject(s)
Device Removal/methods , Stents , Ureteral Obstruction/surgery , Urologic Surgical Procedures/methods , Adolescent , Follow-Up Studies , Humans , Male , Neuroblastoma/complications , Neuroblastoma/surgery , Prosthesis Design , Retroperitoneal Neoplasms/complications , Retroperitoneal Neoplasms/surgery , Ureteral Obstruction/etiologyABSTRACT
Endoscopic injection treatment of vesicoureteral reflux is an increasingly common and successful option. Obstruction is an infrequent postoperative complication, occurring in 1% of patients; delayed onset of obstruction is even rarer. There is a paucity of literature describing possible treatments. We present a novel approach by excision of the implanted material.
