KEY TAKEAWAYS
- The study aimed to investigate the risk of upper tract recurrence in patients with UTUC after DJ stenting.
- Researchers noticed that ureteral stenting does not increase UTUC risk or mortality, but high-risk patients require rigorous long-term follow-up.
It is debated whether the use of a double-J stent (DJ) in patients with bladder cancer before radical cystectomy (RC) might increase the risk of tumor seeding in the upper tract, potentially leading to metachronous upper tract urothelial carcinoma (UTUC).
Osama Mahmoud and the team aimed to evaluate the risk of upper tract recurrence following RC in patients who were managed with a DJ stent.
They performed an inclusive analysis of 699 patients who underwent RC between January 2003 and March 2022, including those with complete perioperative data and pathological outcomes. Patients who received preoperative DJ stenting were compared with those who did not receive internal stenting to assess the development of metachronous UTUC.
Multivariable Cox regression analysis was utilized to identify predictors of UTUC occurrence among various pathological features, and risk factors for mortality following RC were also examined.
About 117 out of 699 patients (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 a higher incidence of hydronephrosis in the DJ group.
At similar follow-up periods (median follow-up 32 months), metachronous UTUC was detected in 4 (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 the presence of CIS (HR 3.83, 95% CI 1.19-12.29, P=0.024) and a positive ureteral margin (HR 5.2, 95% CI 1.38-19.57, P=0.015) were significant predictors of metachronous UTUC. The study is limited by its retrospective nature and relatively short follow-up.
The study concluded that ureteral stenting for managing hydronephrosis in patients with bladder cancer undergoing RC is a viable option, with no increased risk for UTUC or mortality. However, patients with positive ureteral margins and carcinoma in situ (CIS) are identified as high-risk groups for upper tract recurrence and should be subjected to long-term, rigorous follow-up.
No funding information was given.
Source: https://pubmed.ncbi.nlm.nih.gov/39051892/
Mahmoud O, Krafft U, HEß J, et al. (2024). “The impact of double-J ureteral stenting before radical cystectomy on the development of upper tract urothelial carcinoma.” Minerva Urol Nephrol. 2024 Aug;76(4):442-451. doi: 10.23736/S2724-6051.24.05701-X. PMID: 39051892.
