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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.
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    Flexible ureteroscopy for upper tract urothelial carcinoma
    (Springer Nature, 2022) Soria, Francesco; Gontero, Paolo; del Pilar Laguna Pes, Maria; de la Rosette, Jean J. M. C. H.
    Flexible ureteroscopy (fURS) is an essential tool for the diagnosis, risk stratification, and treatment of upper tract urothelial carcinoma (UTUC). fURS should actually be performed in case of uncertainty, for kidney-sparing surgery (KSS), and even before radical surgery being able to provide important information for decision-making regarding perioperative systemic treatments. Flexible diagnostic URS is a stepwise procedure, starting with bladder cystoscopy and urine sampling for selective cytology and eventually ending with tumor ablation. Ureteral access sheaths can be used to allow for multiple biopsies, thereby diminishing the risk of inadequate tumor sampling. While the advent of digital scopes and that of enhanced technology imaging has dramatically improved the quality of the visualization of the upper urinary tract, a demonstration of their clinical utility over fiber-optic scopes is, to date, missing. Meanwhile, the experience of the surgeon and strict adherence to the guidelines recommendations remain the cornerstones of diagnostic fURS and KSS.