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    Adherence to guideline recommendations in the management of upper tract urothelial carcinoma: An analysis of the CROES-UTUC registry
    (Springer, 2022) Baard, Joyce; Shariat, Shahrokh F.; Roupret, Morgan; Yoshida, Takashi; Saita, Alberto; Saltirov, Iliya; Burgos, Javier Revilla; Çelik, Orçun; de la Rosette, Jean J. M. C. H.; del Pilar Laguna Pes, Maria
    Background: The European Association of Urology provides Clinical Practice Guideline on upper tract urothelial carcinoma (UTUC). Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available. Objectives: To evaluate guideline adherence in the management of UTUC by assessing recommendations on diagnostics needed for risk classification and subsequent treatment selection; to assess predictors for the latter. Participants: Data from the Clinical Research Office of the Endo Urology Society UTUC-registry were included for analysis. Statistical analysis: Overall compliance were evaluated by cross-tables, differences in risk groups characteristics and treatment selection were assessed by Chi-square tests, predictors for treatment selection by logistic regression analysis. Results: Data from 2380 patients were included. Imaging by CT-scan had highest adherence (85%) but was low for other diagnostics (17.7–49.7%). Multivariable regression analysis showed higher odds of receiving radical nephroureterectomy in patients with large tumours (OR 5.45, 95% CI 3.77–7.87, p < 0.001), signs of invasion (OR 3.07,CI 2.11–4.46, p < 0.001), high tumour grade (OR 2.05, CI 1.38–3.05, p < 0.001) and multifocality (OR 1.76,CI 1.05–2.97, p =0.032). Conclusions: CT-imaging is the most used and most impactful decision tool for risk-stratification and treatment selection in UTUC. Due to the low compliance in most of the diagnostic recommendations, proper risk stratification is not possible in a significant group of patients raising the question whether current stratification is deemed applicable in daily practice. Established prognostic factors on survival guides decision-making regarding radical versus kidney-sparing surgery. Tumour size was the most influencing factor on treatment decision. Clinical trial registration: The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188).
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    European association of urology guidelines office rapid reaction group: An organisation-wide collaborative effort to adapt the European Association of Urology Guidelines recommendations to the coronavirus disease 2019 era
    (Elsevier, 2020) Ribal, Maria Jose; Cornford, Philip; Briganti, Alberto; Knoll, Thomas; Gravas, Stavros; Babjuk, Marek; Harding, Christopher; Breda, Alberto; Bex, Axel; Rassweiler, Jens J.; Gezen, Ali Serdar; Pini, Giovannalberto; Liatsikos, Evangelos; Giannarini, Gianluca; Mottrie, Alex; Subramaniam, Ramnath; Sofikitis, Nikolaos; Rocco, Bernardo Maria Cesare; Xie, Li-Ping; Witjes, J. Alfred; Mottet, Nicolas; Ljungberg, Boerje; Roupret, Morgan; Laguna, Maria Pilar; Salonia, Andrea; Bonkat, Gernot; Blok, Bertil F. M.; Turk, Christian; Radmayr, Christian; Kitrey, Noam David; Engeler, Daniel S.; Lumen, Nicolaas; Hakenberg, Oliver W.; Watkin, Nick; Hamid, Rizwan; Olsburgh, Jonathon; Darraugh, Julie; Shepherd, Robert; Smith, Emma-Jane; Chapple, Christopher R.; Stenzl, Arnulf; Van Poppel, Hendrik; Wirth, Manfred; Sonksen, Jens; N'Dow, James
    The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.
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    Flexible fibre optic vs digital ureteroscopy and enhanced vs unenhanced imaging for diagnosis and treatment of upper tract urothelial carcinoma (UTUC): Results from the Clinical Research Office of the Endourology Society (CROES)-UTUC registry
    (Wiley, 2021) Soria, Francesco; del Pilar Laguna Pes, Maria; Roupret, Morgan; Garcia-Marchinena, Patricio; Sebastian Gonzalez, Mariano; Habuchi, Tomonori; Erkan, Erkan; Ng, Anthony; Gontero, Paolo; de la Rosette, Jean J. M. C. H.
    Objectives To compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing kidney-sparing surgery (KSS) with fibre-optic (FO) vs digital (D) ureteroscopy (URS). To evaluate the oncological impact of image-enhancement technologies such as narrow-band imaging (NBI) and Image1-S in patients with UTUC. Patients and Methods The Clinical Research Office of the Endourology Society (CROES)-UTUC registry is an international, multicentre, cohort study prospectively collecting data on patients with UTUC. Patients undergoing flexible FO- or D-URS for diagnostic or diagnostic and treatment purposes were included. Differences between groups in terms of overall survival (OS) and disease-free survival (DFS) were evaluated. Results The CROES registry included 2380 patients from 101 centres and 37 countries, of whom 401 patients underwent URS (FO-URS 186 and D-URS 215). FO-URS were performed more frequently for diagnostic purposes, while D-URS was peformed when a combined diagnostic and treatment strategy was planned. Intra- and postoperative complications did not differ between the groups. The 5-year OS and DFS rates were 91.5% and 66.4%, respectively. The mean OS was 42 months for patients receiving FO-URS and 39 months for those undergoing D-URS (P = 0.9); the mean DFS was 28 months in the FO-URS group and 21 months in the D-URS group (P < 0.001). In patients who received URS with treatment purposes, there were no differences in OS (P = 0.9) and DFS (P = 0.7). NBI and Image1-S technologies did not improve OS or DFS over D-URS. Conclusions D-URS did not provide any oncological advantage over FO-URS. Similarly, no differences in terms of OS and DFS were found when image-enhancement technologies were compared to D-URS. These findings underline the importance of surgeon skills and experience, and reinforce the need for the centralisation of UTUC care.