Post Radical Nephroureterectomy Cystoscopic Surveillance and Usage of a Nomogram as a Predictor for Intravesical Recurrence

Intravesical recurrence post radical nephroureterectomy (RNU) is a frequent event requiring intense cystoscopic surveillance. This study includes cystoscopic surveillance and usage of variable predictors for intravesical recurrence after radical nephroureterectomy. The current investigation objective was to recognize intravesical recurrence indicators and build up a tool to allow risk delineated methodology supporting patient advising for cystoscopic surveillance and post-operative intravesical MMC administration.

With a median follow-up of 36 months, intravesical recurrence occurred in 59 patients. IVR after RNU was noted in 59 patients after a median follow-up of 36 months. The probability of intravesical recurrence is 28.6%.The recurrent bladder tumors were managed with endoscopic resection and intravesical chemoimmunotherapy following the standard protocol. The recurrent bladder tumors showed the following characteristics: 3.4%, 3.4%, 8.5%, 37.3%, and 47.5% of tumors were in Ta, T1, T2, T3, and T4stages, respectively. One patient underwent radical cystectomy after a refractory muscle-invasive bladder tumor, and contralateral UTUC developed. Two patients had partial cystectomy after multiple endoscopic resections of T1 tumor, and intravesical chemotherapy failed. For 59 patients who developed bladder recurrence, the optimal cut-off point of early recurrence was determined to be six months after surgery (p=0.042). End-stage renal disease history and surgical margin positive patient has later bladder recurrence.