Adverse Prognostic Impact of Diagnostic Ureterorenoscopy in a Subset of Patients with High-Risk Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

SIMPLE SUMMARY: Although adverse oncological effects of ureterorenoscopy (URS) on disease progression have been of concern, no study has demonstrated such effects in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). The present retrospective study included 143 UTUC patients between 2010 and 2021 at two tertiary care hospitals, of whom 79 received URS prior to RNU. Subgroups were stratified by clinicopathological variables relevant to prognosis. No significant prognostic difference was found between patients with and without URS in the entire cohort. Subgroup analysis demonstrated that URS was significantly associated with worse overall (p < 0.001) and progression-free survival (p = 0.008) in patients with non-papillary and ≥pT3 UTUC. URS was rather associated with better PFS in those with papillary and ≤pT2 UTUC. Diagnostic URS may better be avoided in patients with high-risk UTUC features unless URS is necessary for diagnosing UTUC. ABSTRACT: Background: We hypothesized that diagnostic ureterorenoscopy (URS) may adversely affect prognosis in a subset of patients with high-risk upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Methods: The present retrospective study included 143 patients with UTUC treated between 2010 and 2021 at two tertiary care hospitals, of whom 79 received URS prior to RNU. Subgroups were stratified by clinicopathological variables relevant to prognosis. The primary endpoint was to evaluate the prognostic impact of URS on overall survival (OS) and progression-free survival (PFS) after RNU. Results: During follow-up (median 54 months for survivors), 32 cases of all-cause mortality and 40 cases of progression were recorded. No significant difference was found in OS or PFS between patients with and without URS. Subgroup analysis demonstrated that URS was significantly associated with worse OS (p < 0.001) and PFS (p = 0.008) in 29 patients with non-papillary and ≥pT3 UTUC. Importantly, URS did not have any adverse effects on prognosis in 62 patients with papillary and ≤pT2 UTUC (p = 0.005). Conclusions: URS may adversely affect prognosis of UTUC patients, specifically non-papillary and ≥pT3 disease. URS may better be avoided in patients with high-risk UTUC features unless URS is necessary to diagnose UTUC. This study also corroborates the oncological safety of URS in those with low-risk UTUC.