Department of Urology, University Hospital Essen, Essen, Germany -
Department of Urology, South Valley University, Qena, Egypt -
Minerva Urol Nephrol. 2024 Aug;76(4):442-451. doi: 10.23736/S2724-6051.24.05701-X.
It is controversial whether the use of a double-J stent (DJ) in patients with bladder cancer before radical cystectomy (RC) increases the risk of tumour seeding in the upper tract and thus the risk of metachronous upper tract urothelial carcinoma (UTUC). The aim of our study is to investigate the risk of upper tract recurrence after RC in patients previously managed with a DJ stent.
A total of 699 patients who had undergone RC between January 2003 and March 2022 with complete perioperative data and pathological outcome were included in our study. Patients treated preoperatively with a DJ stent were identified and compared for development of metachronous UTUC with those who did not receive prior internal stenting. Multivariable Cox regression analysis was used to determine predictors of UTUC occurrence among the possible pathological features; risk factors for mortality after RC were also examined.
Of 699 patients, 117 (16.7%) were managed preoperatively with a DJ stent. The overall probability of metachronous UTUC was 1%, 4% and 6% at 1, 3 and 5 years, respectively. The groups with and without DJ stenting were comparable regarding their clinicopathologic features, except for the higher incidence of hydronephrosis in the DJ group. At similar follow-up periods (median follow-up 32 months), metachronous UTUC was detected in four (3.4%) patients in the DJ group and in 13 (2.2%) in the non-stented group (P=0.44). The median interval (IQR) from cystectomy to UTUC was 40.5 (20-49) months in the DJ group and 37 (24-82) in the non-stented group (P=0.7). In the multivariable analysis, only presence of CIS (HR 3.83, 95% CI 1.19-12.29, P=0.024) and positive ureteral margin (HR=5.2, 95% CI 1.38-19.57, P=0.015) were predictors of metachronous UTUC. The study is limited by the retrospective nature and relatively short follow-up.
Ureteral stenting for management of hydronephrosis in patients with bladder cancer undergoing RC is a viable option, without higher risk for UTUC or mortality. Patients with positive ureteral margin and CIS are considered high-risk groups for upper tract recurrence and should receive long-term, rigorous follow-up.
在根治性膀胱切除术 (RC) 前使用双 J 支架 (DJ) 是否会增加膀胱癌患者上尿路肿瘤播散的风险，进而增加同时发生上尿路尿路上皮癌 (UTUC) 的风险，目前仍存在争议。我们的研究旨在探讨既往使用 DJ 支架治疗的患者在接受 RC 后上尿路复发的风险。
共纳入 699 例 2003 年 1 月至 2022 年 3 月期间接受 RC 的患者，所有患者均具有完整的围手术期数据和病理结果。确定并比较了术前接受 DJ 支架治疗和未接受术前内置支架治疗的患者发生同时发生 UTUC 的情况。多变量 Cox 回归分析用于确定可能的病理特征中 UTUC 发生的预测因素；还检查了 RC 后死亡率的危险因素。
699 例患者中，117 例 (16.7%) 术前接受 DJ 支架治疗。无支架组和有支架组在临床病理特征方面无差异，除 DJ 组中存在更高的肾盂积水发生率外。无支架组和有支架组的患者在相似的随访期（中位随访 32 个月）内，分别有 4 例（3.4%）和 13 例（2.2%）发生同时发生 UTUC（P=0.44）。DJ 组的膀胱切除术至 UTUC 的中位间隔（IQR）为 40.5（20-49）个月，无支架组为 37（24-82）个月（P=0.7）。在多变量分析中，仅 CIS 的存在（HR 3.83，95%CI 1.19-12.29，P=0.024）和输尿管切缘阳性（HR=5.2，95%CI 1.38-19.57，P=0.015）是同时发生 UTUC 的预测因素。该研究存在回顾性和随访时间相对较短的局限性。
对于接受 RC 的膀胱癌患者，为管理肾盂积水而使用输尿管支架是一种可行的选择，不会增加 UTUC 或死亡率的风险。输尿管切缘阳性和 CIS 的患者被认为是上尿路复发的高危人群，应接受长期、严格的随访。
