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    Concomitant bladder tumor is a risk factor for bladder recurrence but not upper tract
    (MDPI, 2022) Liu, Kang; Zhao, Hongda; Alvarez-Maestro, Mario; Gravas, Stavros; Van Renterghem, Koen; Zeng, Guohua; Ng, Chi-Fai; del Pilar Laguna Pes, Maria; Teoh, Jeremy Yuen-Chun; de la Rosette, Jean J. M. C. H.
    Objective: To evaluate the clinical outcomes of UTUC patients with or without concurrent bladder tumor. Design, Setting, and Participants: The Clinical Research Office of the Endourology Society-Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry included 1134 UTUC patients with or without concurrent bladder tumor treated between 2014 and 2019. Results: In 218 (19.2%) cases, concurrent bladder tumor was present, while in 916 (80.8%) patients, no bladder cancer was found. In the multivariable Cox regression analysis, concomitant bladder tumor (hazard ratio (HR) 1.562, 95% confidence interval (CI) 0.954-2.560, p = 0.076) indicated a trend associated with recurrence-free survival for UTUC. Further data dissection confirmed that concomitant bladder tumor is a risk factor of bladder recurrence (HR 1.874, 95% CI 1.104-3.183, p = 0.020) but not UTUC recurrence (HR 0.876, 95% CI 0.292-2.625, p = 0.812). Kidney-sparing surgery (KSS) (HR 3.940, 95% CI 1.352-11.486, p = 0.012), pathological T staging >= pT2 (HR 2.840, 95% 1.039-7.763, p = 0.042) were significantly associated with UTUC recurrence. KSS does not affect bladder recurrence (HR 0.619, 95% CI 0.242-1.580, p = 0.315). A limitation is the retrospective nature of the present study analysis. Conclusions: The presence of concomitant bladder tumor does not increase risk of UTUC recurrence, but it results in an increased risk of bladder recurrence. KSS does not affect bladder recurrence and can still be considered in patients with concomitant bladder tumor.
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    Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey
    (Elsevier (Singapore) Pte. Ltd., 2024) Cheng, Bryan Kwun-Chung; Yuen, Steffi Kar-Kei; Castellani, Daniele; Wroclawski, Marcelo Langer; Zhao, Hongda; Chiruvella, Mallikarjuna; Chua, Wei -Jin; Tiong, Ho-Yee; Tanıdır, Yılören; de la Rosette, Jean J. M. C. H.; Gauhar, Vineet
    Objective: To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists' knowledge, attitudes, and practices for benign prostatic obstruction surgeries. Methods: A 36 -item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were "agree or strongly agree" and less than or equal to 15% responses were "disagree or strongly disagree" (consensus agree), or when more than or equal to 70% responses were "disagree or strongly disagree" and less than or equal to 15% responses were "agree or strongly agree" (consensus disagree). Results: The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post -operative recovery (n=4 31, 74 .3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift (R) (n=361, 62.2%), Rezum (R) (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift (R), Rezum (R), and iTIND (R) over transurethral resection of the prostate with regard to blood loss, recovery, day surgery feasibility, and post -operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift (R), Rezum (R), and iTIND (R) over transurethral resection of the prostate with regard to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. Conclusion: Minimal blood loss, fast post -operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift (R), Rezum (R), and EEP were regarded as MIST by most urologists.
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    Impact of pre-operative ureteroscopy on bladder recurrence following nephroureterectomy for utuc
    (2024) Wong, Chris Ho Ming; Ko, Ivan Ching Ho; Leung, David Ka Wai; Liu, Kang; Zhao, Hongda; Alvarez Maestro, Mario; del Pilar Laguna Pes, Maria; de la Rosette, Jean J. M. C. H.; Teoh, Jeremy Yuen Chun
    (1) Introduction: Diagnostic ureteroscopy (URS) is an important component in the workup of upper tract urothelial carcinoma (UTUC). Whether URS was associated with increased recurrence in the bladder was not fully concluded. The current study aimed to evaluate the implication of URS on the incidences of intravesical recurrence following radical nephroureterectomy (RNU) in non-metastatic UTUC patients without prior history of bladder cancer via multi-institutional data. (2) Patients and Methods: Data were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) registry, a prospective, multicentre database. Patients with non-metastatic UTUC treated with RNU were divided into two groups: those undergoing upfront RNU and those having diagnostic URS prior to RNU. Intravesical recurrence-free survival (IVRS) was the primary endpoint, evaluated through Kaplan–Meier analysis and multivariate Cox regression. Cases with adequate follow-up data were included. (3) Results: The analysis included 269 patients. Of these, 137 (50.9%) received upfront RNU and 132 (49.1%) received pre-RNU URS. The URS group exhibited an inferior 24-month IVRS compared to the upfront RNU group (HR = 1.705, 95% CI = 1.082–2.688; p = 0.020). Multivariate analysis confirmed URS as the only significant predictor of IVR (p = 0.019). Ureteric access sheath usage, flexible ureteroscopy, ureteric biopsy, retrograde contrast studies, and the duration of URS did not significantly affect IVRS. (4) Conclusions: Diagnostic URS prior to RNU was found to be associated with an increased risk of IVR in patients with UTUC. The risk was not significantly influenced by auxiliary procedures during URS. Physicians were advised to meticulously evaluate the necessity of diagnostic URS.
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    Impact of previous malignancy at diagnosis on oncological outcomes of upper tract urothelial carcinoma
    (NLM (Medline), 2023) Zhao, Hongda; Liu, Kang; Giannakopoulos, Stilianos; Yürük, Emrah; de Naeyer, Geert; Álvarez-Maestro, Mario; Ng, Chi-Fai; del Pilar Laguna Pes, Maria; de la Rosette, Jean J. M. C. H.; Yuen-Chun Teoh, Jeremy
    BACKGROUND: The evidence of prognostic factors and individualized surveillance strategies for upper tract urothelial carcinoma are still weak. OBJECTIVES: To evaluate whether the history of previous malignancy (HPM) affects the oncological outcomes of upper tract urothelial carcinoma (UTUC). METHODS: The CROES-UTUC registry is an international, observational, multicenter cohort study on patients diagnosed with UTUC. Patient and disease characteristics from 2380 patients with UTUC were collected. The primary outcome of this study was recurrence-free survival. Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to their HPM. RESULTS: A total of 996 patients were included in this study. With a median recurrence-free survival time of 7.2 months and a median follow-up time of 9.2 months, 19.5% of patients had disease recurrence. The recurrence-free survival rate in the HPM group was 75.7%, which was significantly lower than non-HPM group (82.7%, P?=?0.012). Kaplan-Meier analyses also showed that HPM could increase the risk of upper tract recurrence (P?=?0.048). Furthermore, patients with a history of non-urothelial cancers had a higher risk of intravesical recurrence (P?=?0.003), and patients with a history of urothelial cancers had a higher risk of upper tract recurrence (P?=?0.015). Upon multivariate Cox regression analysis, the history of non-urothelial cancer was a risk factor for intravesical recurrence (P?=?0.004), and the history of urothelial cancer was a risk factor for upper tract recurrence (P?=?0.006). CONCLUSION: Both previous non-urothelial and urothelial malignancy could increase the risk of tumor recurrence. But different cancer types may increase different sites' risk of tumor recurrence for patients with UTUC. According to present study, more personalized follow-up plans and active treatment strategies should be considered for UTUC patients.
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    Kidney-sparing surgery has equivalent oncological outcomes to radical nephroureterectomy for ureteral urothelial carcinoma
    (2024) Liu, Kang; Zhao, Hongda; Ng, Chi Fai; Teoh, Jeremy Yuen Chun; del Pilar Laguna Pes, Maria; de la Rosette, Jean J. M. C. H.
    INTRODUCTION AND OBJECTIVE: Kidney-sparing surgery (KSS) for upper tract urothelial cancer (UTUC) has gained increasing interest recently. However, there is limited contemporary data regarding the role of KSS in ureteral urothelial carcinoma. Therefore, we investigated the survival outcomes of ureteral urothelial carcinoma after KSS from a large prospective international UTUC registry. METHODS: The Clinical Research Office of the Endourology Society-Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry included UTUC patients who received KSS or radical nephroureterectomy (RNU) between 2014 and 2019. In this study, we included patients with ureteral UTUC only. Study outcomes included overall survival (OS), cancer-specific survival (CSS), upper tract recurrence-free survival (RFS), intravesical RFS, progression-free survival (PFS), and metastasis-free survival (MFS). Propensity score matching (PSM) was performed to balance the tumour features’ differences between groups. RESULTS: Of 391 patients with ureteral UTUC, 309 (79.0%) received RNU, and 82 (21.0%) received KSS by ureteroscopy with laser ablation (n=28) or segmental resection (n=54). After PSM, there were no differences in OS (p=0.525), CSS (p=0.487), upper tract RFS (p=0.147), intravesical RFS (p=0.989), PFS (p=0.617), and MFS (p=0.336) between KSS and RNU. Both ureteroscopic ablation and segmental resection had similar OS, CSS, intravesical RFS, PFS, and MFS with RNU. Proximal ureteral UTUC had worse OS and CSS outcomes than other tumour locations following segmental resection. CONCLUSIONS: In patients with ureteral UTUC, no significant differences in long-term survival outcomes were observed between KSS and RNU. Proximal ureteral UTUC had worse survival outcomes over other tumour locations following segmental resection.
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    The prognostic role of body mass index on oncological outcomes of upper tract urothelial carcinoma
    (Multidisciplinary Digital Publishing Institute (MDPI), 2023) Liu, Kang; Zhao, Hongda; Ng, Chi-Fai; Teoh, Jeremy Yuen-Chun; del Pilar Laguna Pes, Maria; Gontero, Paolo; Saltirov, Iliya; de la Rosette, Jean J. M. C. H.
    Simple Summary In patients with upper tract urothelial carcinoma, the impact of body mass index on oncological outcomes is still a matter of debate. We use the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract Registry to compare the overall survival, cancer-specific survival, and recurrence-free survival between normal weight, overweight and obese patients. After balancing the clinicopathological features by propensity score matching, being overweight/obese (body mass index >= 25.0 kg/m2) was associated with a decreased risk of recurrence in upper tract urothelial carcinoma patients but not overall survival or cancer-specific survival.Abstract (1) Objective: The aim of this study was to evaluate whether overweight and obese upper urinary tract carcinoma (UTUC) patients have better or worse survival outcomes. (2) Methods: The Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry was used to extract the data of normal-weight or overweight/obese UTUC patients between 2014 and 2019. Patients with a BMI between 18.5 and 24.9 kg/m2 were defined as normal weight, while those with a BMI >= 25.0 kg/m2 were considered as overweight/obese group. We compared baseline characteristics among groups categorized by different BMIs. The Kaplan-Meier plots with the log-rank test were used to explore the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Propensity score matching was performed to eliminate the differences in clinicopathologic features. The Declaration of Helsinki was followed during this study. (3) Results: Of 1196 UTUC patients, 486 patients (40.6%) were normal weight, while 710 patients (59.4%) presented with a BMI >= 25.0 kg/m2. After propensity score matching, all baseline characteristics were balanced. For normal weight and overweight/obese patients, 2-year overall survival rates were 77.8% and 87.2%, 2-year cancer-specific survival rates were 85.2% and 92.7%, and 2-year recurrence rates were 50.6% and 73.0%, respectively. The overweight patients obtained a better RFS (p = 0.003, HR 0.548, 95% CI 0.368-0.916) while their OS (p = 0.373, HR 0.761, 95% CI 0.416-1.390) and CSS (p = 0.272, HR 0.640, 95% CI 0.287-1.427) were similar to normal weight patients. (4) Conclusions: Being overweight/obese (BMI >= 25.0 kg/m2) was associated with a decreased risk of recurrence in UTUC patients but not overall survival or cancer-specific survival.