Ureteral orifice involvement by urothelial carcinoma: long term oncologic and functional outcomes

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0218


ORIGINAL ARTICLE

Muammer Altok 1, Ali F. Sahin 2, Mehmet I. Gokce 3, Gokhan R. Ekin 4, Rauf Taner Divrik 5
1 Department of Urology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA; 2 Department of Urology, Sivas Numune Hospital, Sivas, Turkey; 3 Department of Urology, School of Medicine, Ankara University, Ankara, Turkey; 4 Department of Urology, Tepecik Education and Research Hospital, Izmir, Turkey; 5 Department of Urology, Private Ege City Hospital, Izmir, Turkey

ABSTRACT

Purpose: Bladder cancer (BC) may involve the ureteral orifice, and the resection of the orifice has oncological and functional consequences such as development of up­per tract urothelial carcinoma (UTUC), vesicoureteral reflux or ureteral stenosis. The aim of this study was to investigate the oncological and functional outcomes of the ureteral orifice resection in BC patients and determine the predictive factors for UTUC development.

Materials and methods: A total of 1359 patients diagnosed with BC, between 1992 and 2012, were reviewed retrospectively. Patients were grouped with respect to orifice resection and compared for development of UTUC, survival and functional outcomes. Kaplan-Meier method was used to compare survival outcomes. Logistic regression analysis was performed to determine predictors of UTUC development.

Results: Ureteral orifice involvement was detected in 138 (10.2%) patients. The rate of synchronous (10.1% vs. 0.7%, p=0.0001) and metachronous (5.3% vs. 0.9%, p=0.0001) UTUC development was found to be higher in patients with ureteral orifice involve­ment. Orifice involvement and tumor stage were found to be associated with develop­ment of UTUC in the regression analysis. Overall (p=0.963) and cancer specific survival rates (p=0.629) were found to be similar. Hydronephrosis was also significantly higher in patients with orifice involved BC, due to the orifice obstruction caused by the tumor (33.3% vs. 13.9%, p<0.05).

Conclusions: BC with ureteral orifice involvement has significantly increased the risk of having synchronous or metachronous UTUC. However, orifice involvement was not found to be associated with survival outcomes. Development of stricture due to resec­tion is a very rare complication.

Keywords: Urinary Bladder Neoplasms; Hydronephrosis; Therapeutics

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