Risk factors for intravesical recurrence after radical nephrourethrectomy in upper urinary tract urothelial tumors: retrospective single-center study

Objective: We examined factors predicting metachronous recurrence of bladder cancer in our series of patients who underwent radical nephroureterectomy (RNU) for upper system urothelial carcinoma (UTUC). Material and Methods: Patients with UTUC-induced RNU in our center from September 2009 to March 2020 were included in the study. Patients were classified as having and not having an intravesical recurrence (IVR), and the factors predicting recurrence were evaluated. Results: A total of 50 patients were included in the study. IVR was developed in 19 (38%) of 50 patients, with a mean follow-up of 39.5 ± 25.3 months. There was no significant difference between the two groups in demographic characteristics, admission hemoglobin, glomerular filtration rate, and degree of hydronephrosis in preoperative ureterorenoscopy and cytology positivity history (p>0.05). The IVR (+) group had significantly more previous history of bladder cancer (35.5% vs. 52.6%, p=0.019, respectively). While the number of patients with ureteral tumors was 10 (32.3%) in the IVR (-) group, it was 9 (47.4%) in the IVR (+) group, and it was significantly higher. There are 28 (56%) patients with T2-T4 pathology in the entire patient group, and the rate is significantly greater in the IVR (+) group (63.2% vs. 51.6%, p=0.038, respectively). Conclusion: Caution should be exercised for metachronous bladder cancer recurrence in patients with a previous history of bladder cancer, especially in ureteral and high pathological T-stage UTUCs.  Keywords: upper urinary tract urothelial carcinoma, intravesical recurrence, risk factor, nephroureterectomy