Ureteroscopic biopsy before radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is associated with increased risk of intravesical recurrence, a new study finds.

Among 834 patients who underwent RNU during 1995-2019, 210 (25.2%) had no diagnostic ureteroscopy, 57 (6.6%) had a percutaneous biopsy, 125 (15.0%) had a ureteroscopy without biopsy, and 442 (53.0%) had a ureteroscopic biopsy. The intravesical recurrence rate at 2 years was highest for the ureteroscopic biopsy group (21.9%), followed by the ureteroscopy without biopsy (18.4%), no ureteroscopy (15.0%), and percutaneous biopsy groups (12.7%), respectively.

Multivariable analysis found that patients who underwent ureteroscopic biopsy had a significant 40% increased risk of intravesical recurrence compared with no ureteroscopy or percutaneous biopsy, Aaron M. Potretzke, MD, of Mayo Clinic in Rochester, Minnesota, and colleagues reported in The Journal of Urology. Ureteroscopy without endoscopic biopsy and percutaneous biopsy were not associated with increased risks of intravesical recurrence.

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The investigators additionally performed a meta-analysis including 11 other case series and found that ureteroscopy vs no ureteroscopy was significantly associated with a 47% increased risk of intravesical recurrence.

“These data suggest that manipulation of UTUC during ureteroscopic biopsy may pose unique oncologic risks for downstream urothelial carcinoma recurrences,” Dr Potretzke’s team stated. “The decision to perform ureteroscopic biopsy should take into account relevant clinical and tumor factors and guidelines should consider individualized recommendations for UTUC diagnosis to decrease intravesical recurrences. Additionally, our data supports development of prospective clinical trials evaluating periprocedural intravesical chemotherapy or saline irrigation for preventing bladder cancer recurrence in patients undergoing ureteroscopic biopsy for UTUC.”

The investigators had no information on whether patients had multiple ureteroscopic biopsies or procedures using access sheaths or ureteral stents, precluding some analyses.

Disclosure: Some study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Sharma V, Miest TS, Juvet TS, et al. The impact of upper tract urothelial carcinoma diagnostic modality on intravesical recurrence after radical nephroureterectomy: a single institution series and updated meta-analysis. J Urol. Published April 28, 2021. doi:10.1097/JU.0000000000001834