Di Bello Francesco, Gallioli Andrea, Cannoletta Donato, Mancon Stefano, Territo Angelo, Diéguez Lucia, Izquierdo Paula, Hernandez Pedro, Sopena Josep Maria Gaya, Palou Joan, Breda Alberto
Department of Urology, Fundació Puigvert, Barcelona, Spain.
Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy.
BJU Int. 2025 Aug 28. doi: 10.1111/bju.16902.
To assess the role of ureteroscopy (URS) with laser ablation on oncological outcomes, namely, intravesical recurrence (IVR) rate, radical nephroureterectomy (RNU)-to-treat ratio and overall survival (OS), in patients with upper tract urothelial carcinoma (UTUC), an area of study that has been insufficiently addressed in the literature.
A systematic search (PROSPERO: CRD42025642480) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A pooled analysis was performed to quantify the effect size (ES) for IVR rate, radical nephroureterectomy (RNU)-to-treat ratio and OS. Subgroup analyses were performed to evaluate patients who received postoperative instillations and to compare URS with laser ablation to RNU.
Overall, 24 studies involving 1904 patients were included in the final analysis. The overall rate of IVR was 23.7% (n = 453). The overall pooled analysis showed an ES for IVR of 0.33, for RNU-to-treat ratio of 0.23, and for OS of 0.62 (all P ≤ 0.005). In the comparison between URS and RNU, the pooled ES of URS for IVR was 1.14 and for OS it was 1.43 (all P > 0.05). Within the subgroup analysis of patients who received postoperative instillations, the pooled ES for IVR was 0.38 (P = 0.029) and for RNU-to-treat ratio it was 0.25 (P = 0.012).
In this systematic review, URS with laser ablation was found to exert a negligible effect on IVR rate. Moreover, no statistically significant differences in IVR nor in OS were recorded when URS was compared to RNU. URS can be performed without compromising the oncological outcomes of patients with UTUC.
评估输尿管镜检查（URS）联合激光消融对上尿路尿路上皮癌（UTUC）患者肿瘤学结局的作用，即膀胱内复发（IVR）率、根治性肾输尿管切除术（RNU）治疗率和总生存期（OS），该研究领域在文献中尚未得到充分探讨。
根据系统评价和Meta分析的首选报告项目（PRISMA）声明进行系统检索（PROSPERO：CRD42025642480）。进行汇总分析以量化IVR率、根治性肾输尿管切除术（RNU）治疗率和OS的效应大小（ES）。进行亚组分析以评估接受术后灌注的患者，并将URS联合激光消融与RNU进行比较。
总体而言，最终分析纳入了24项研究，涉及1904例患者。IVR的总体发生率为23.7%（n = 453）。总体汇总分析显示，IVR的ES为0.33，RNU治疗率的ES为0.23，OS的ES为0.62（所有P≤0.005）。在URS与RNU的比较中，URS的IVR汇总ES为1.14，OS为1.43（所有P>0.05）。在接受术后灌注的患者亚组分析中，IVR的汇总ES为0.38（P = 0.029），RNU治疗率为0.25（P = 0.012）。
在本系统评价中，发现URS联合激光消融对IVR率的影响可忽略不计。此外，将URS与RNU进行比较时，IVR和OS均未记录到统计学上的显著差异。URS的实施不会影响UTUC患者的肿瘤学结局。
