(Lynch syndrome patients) Impact of Ureteroscopy Prior to Nephroureterectomy for Upper Tracturothelial Carcinoma on Oncologic Outcomes- Beyond the Abstract.

Blogger's Note: not specific to Lynch Syndrome but to surgical technique quandries

Impact of Ureteroscopy Prior to Nephroureterectomy for Upper Tracturothelial Carcinoma on Oncologic Outcomes- Beyond the Abstract

  Currently, there are conflicting data in literature assessing the association between URS and risk of intravesical recurrence, with most studies, like ours, consisting of small cohorts and adjusting for different covariates. A multi-institutional study would clarify whether a significant association between URS (ureteroscopy) and IR (intravesical tumor recurrences) till exists once more measured covariates are adjusted for. Results from such a study could aid treating physicians when deciding whether the benefits of pre−NU URS, including more accurate staging and possible endoscopic ablation, outweigh the increased risk of post−NU IR.

 Upper tract urothelial cell carcinoma (UTUC) is challenging to diagnose, stage, and manage. Historically, radical nephroureterectomy (NU) was performed for clinical suspicion of UTUC based primarily on imaging, with or without positive cytology. In the modern era, after the development of modern endoscopy techniques, many urologists will perform ureteroscopy (URS) prior to NU with diagnostic or therapeutic intent. The concern with this procedure is that it can disturb the tumor microenvironment and increase pyelovenous pressure with reports in the literature of disease progression following URS (1-4). Although these reports are anecdotal, it has led some urologists to advocate against upper tract instrumentation prior to NU. To address this concern, we compared the oncologic outcomes of patients with UTUC and no history of bladder cancer treated at our institution who were managed with and without URS prior to NU.....