Preoperative diagnostic ureteroscopy (URS) before radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) is a risk factor for intravesical recurrence, according to investigators.

In a study of 453 patients with UTUC undergoing radical nephroureterectomy (RNU), a significantly higher proportion of patients who underwent preoperative URS experienced intravesical recurrence (IVR) than those who did not (43.8% vs 26.9%), Younsoo Chung, MD, of Seoul National University Bundang Hospital in Seongnam, and colleagues reported in Investigative and Clinical Urology. The median time to recurrence was 107 months. The 5-year IVR-free survival rates were significantly lower in the ureteroscopy group (56.2% vs 73.1%).

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Patients who had underwent preoperative ureteroscopy had a significantly 1.4-fold increased risk of IVR compared with patients who did not, after adjusting for tumor stage, location, and other factors, according to investigators.

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The authors explained that URS procedures may increase the risk of IVR by causing seeding or spillage of tumor cells.

“Preoperative diagnostic URS before RNU was a significant factor in IVR,” they concluded. “Therefore, we should carefully consider preoperative diagnostic URS before RNU for nonobvious ureteral lesions. Rather, it is better to not perform URS before surgery.”


Chung Y, Lee DH, Lee M, et al. Impact of diagnostic ureteroscopy before radical nephroureterectomy on intravesical recurrence in patients with upper tract urothelial cancer. Investig Clin Urol. 2020;61:158-165.