Presented by: Hen Hendel MD
Rabin Medical Center

Introduction

The endoscopic treatment of LG-UTUC has gained significant momentum as a therapeutic approach in recent years. The choice of appropriate treatment requires a thorough evaluation of the treatment's long-term effectiveness, utilizing data from the literature as well as real-world outcomes. In this study, we present long-term follow-up data after endoscopic treatment for LG-UTUC.

Materials

We retrospectively identified patients who underwent endoscopic treatment for LG-UTUC in our department until 2022. Clinical follow-up was conducted, and medical records were reviewed up until the beginning of 2023. Data on laboratory parameters, pathology, and morbidity were collected and analysed.

Results

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The study cohort comprised 62 patients who underwent endoscopic treatment for LG-UTUC, including 5 patients (8.1%) with bilateral disease. The median age at presentation was 70.5 years (range: 51-89), and risk factors such as cardiovascular disease and hypertension were present in 43.3% of patients. Prior bladder tumor history was observed in 51.6% of cases, with 45.1% of patients having a low-grade pathology and 8.1% having a high-grade pathology. The average tumor size during the initial surgery was 13.14 mm.

 

The median follow-up period was 5 years (interquartile range: 2.8-8). Over the follow-up period, patients underwent an average of 6.83 ureteroscopies (range: 1-24), with an average of 1.39 ureteroscopies per year. The average hospitalization duration was 16.27 days (range: 2-56). Monitoring of GFR levels revealed an average decrease of 9.86 ml/min/1.73 m².

 

During follow-up, tumor recurrence in the upper urinary tract was observed in 83.3% of patients, while 8.1% exhibited a transformation to a higher-grade malignancy. Nephroureterectomy was required in 20.1% of patients at an average of 3.45 years from diagnosis. Metastatic spread occurred in 4.8% of patients, with an average time to detection of 2.62 years. The average time to death from any cause was 6.83 years.

Conclusion

Renal preservation treatment for LG-UTUC demonstrates a success rate of 79.9% in our patient cohort, based on a median follow-up of 5 years. Although the risk of metastatic spread is relatively low, the recurrence rate in the upper urinary tract remains high. Further research and strategies are warranted to address these challenges and optimize patient outcomes

Funding

None

Co-Authors

Yaron Ehrlich, MD
Rabin Medical Center

Abd Elhalim Darawsha, MD
Rabin Medical Center

Chen Shenhar, MD
Rabin Medical Center

Ron Gilad, MD
Rabin Medical Center

David Lifshitz, MD
Rabin Medical Center