PURPOSE There have recent reports in the literature of increased rates of bladder recurrence (BR) after radical nephroureterectomy (RNU) when diagnostic flexible ureteroscopy (DFU) was performed before RNU. The technical heterogeneity of DFU was a major bias in these studies. Our purpose was to evaluate the impact of a standardized DFU technique before RNU on the risk of BR. METHODS A retrospective monocenter study including patients who underwent RNU for upper tract urothelial carcinoma (UTUC) between 2005 and 2017. 171 patients were identified. 78 patients were excluded owing to a history of bladder cancer before RNU or neo-adjuvant/adjuvant chemotherapy. 93 included patients were stratified according to pre-RNU ureteroscopy (DFU + 70 patients) or no pre-RNU ureteroscopy (DFU-23 patients). The standardized DFU technique consisted of systematic ureteral sheath (ch9-10), flexible ureteroscopy, biopsy, and drainage with a mono-J/bladder catheter to avoid contact of contaminated urine of the upper tract with the bladder. RESULTS Epidemiological, initial staging, and postoperative tumoral characteristics were similar in both groups. Mean follow-up was 35 months [2-166], 47(50%) BR occurred with 41(87%) in the DFU + group, and pre-RNU-DFU was an independent predictive factor of BR (OR = 4[1.4-11.9], P = 0.01) (Cox regression model). The characteristics of BR were similar in both groups, although BR occurred earlier in DFU + (427 days vs. 226 days (P = 0.07)). CONCLUSION Bladder recurrence after diagnostic ureteroscopy + nephroureterectomy was high despite technical precautions to avoid contact of bladder mucosa with contaminated urine from the upper urinary tract. Post-DFU endovesical instillation should be investigated.

中文翻译：

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尽管有技术上的预防措施以避免尿道上溢，但在肾结石切除术之前对尿路上皮癌进行的诊断性输尿管镜检查与膀胱复发的高风险相关。

目的最近有文献报道，当在RNU之前进行诊断性输尿管镜检查（DFU）时，根治性肾输尿管切除术（RNU）后膀胱复发（BR）的发生率增加。DFU的技术异质性是这些研究的主要偏见。我们的目的是评估RNU之前的标准化DFU技术对BR风险的影响。方法一项回顾性单中心研究包括2005年至2017年接受RNU上尿路尿路上皮癌（UTUC）治疗的患者。确定了171例患者。由于在RNU或新辅助/辅助化疗之前有膀胱癌病史，排除了78例患者。纳入的93例患者根据RNU之前的输尿管镜检查（DFU + 70例）或无RNU之前的输尿管镜检查（DFU-23例）进行分层。标准化的DFU技术包括系统性输尿管护套（ch9-10），柔性输尿管镜检查，活检和单J /膀胱导管引流术，以避免上尿道受污染的尿液与膀胱接触。结果两组的流行病学，初始分期和术后肿瘤特征相似。平均随访时间为35个月[2-166]，DFU +组发生BR（47（50％），41（87％），RNU-DFU之前是BR的独立预测因素（OR = 4 [ 1.4-11.9]，P = 0.01）（Cox回归模型）。两组的BR特征相似，尽管BR在DFU +中发生较早（427天对226天（P = 0.07））。结论尽管采取了技术预防措施以避免膀胱粘膜与上尿路污染尿液接触，但诊断性输尿管镜+肾结直肠切除术后膀胱复发率很高。DFU后膀胱内滴注应进行调查。