Preoperative sterile pyuria may be a useful, low-cost predictor of intravesical recurrence in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy or segmental ureterectomy, according to investigators.

Of 176 patients with UTUC seen at their hospital, 91 (51.7%) had a preoperative urine specimen containing 5 or more white blood cells per high-power field in the absence of bacteria in urine culture. Tumor characteristics (grade, T stage, multiplicity, and recurrence history) did not differ significantly between patients with and without preoperative sterile pyuria at baseline.

Bladder cancer recurred in 49 (53.8%) patients with pyuria and in 16 (18.8%) patients without pyuria. After a multivariable analysis, preoperative sterile pyuria, diabetes mellitus, high-grade tumor, and lymphovascular invasion significantly and independently predicted intravesical recurrence. Only lymphovascular invasion independently influenced overall survival, however.

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Inflammation and oxidative stress may play a role in recurrence, according to the researchers.

“To the best of our knowledge, the present study is the first to evaluate the prognostic value of preoperative sterile pyuria as an early sign of IVR [intravesical recurrence] in patients with UTUC, which may help clinicians in planning subsequent treatment after radical surgery,” Jae Young Park of Korea University Ansan Hospital and colleagues stated in Investigative and Clinical Urology.

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Jeon BJ, Tae BS, Choi H, et al. Preoperative sterile pyuria as a prognostic biomarker for intravesical recurrence in upper urinary tract urothelial carcinoma. Investig Clin Urol 2020;61:51-58. doi: 10.4111/icu.2020.61.1.51