OBJECTIVE: Sparse data exist on the impact of upper urinary tract (UUT) decompression on the risk of UUT recurrence in patients with bladder cancer (BCa). This study aims to evaluate whether Double J stenting (DJS) can increase the risk of UUT recurrence compared to percutaneous nephrostomy (PCN) placement. MATERIALS AND METHODS: We retrospectively analyzed data from 1550 patients with cTa-T3NanyM0 BCa who underwent radical cystectomy (RC) between at 12 tertiary care centers (1990-2020). Patients with complete follow-up, no prior history of UUT cancer, and who required UUT decompression for preoperative hydronephrosis were selected. Hydronephrosis grade was defined according to established scoring systems. UUT recurrence was diagnosed through imaging, urinary cytology, and confirmed by selective cytology and ureteroscopy when possible. Propensity scores were computed to determine overlap weights and balance groups. Kaplan-Meier analyses estimated UUT recurrence-free survival (RFS), cancer-specific (CSS), and overall survival (OS) before and after weighting. Cox regression analyses before and after weighting were fitted to predict UUT recurrence. RESULTS: Of 524 included patients, 132 (25%) and 392 (75%) patients were managed with DJS and PCN placement, respectively. Patients who received PCN had higher grade (≥ 3) of obstruction (34% vs. 14%) and pT3-4 tumors (70% vs. 36%) than patients with DJS. During a median follow-up of 19 months, 2-years UUT-RFS did not differ between groups (95% for PCN vs 92% for DJS, weighted HR 1.41, 95% CI, 0.55-3.59). There was no difference in 2-years weighted CSS (74% vs. 74%) and OS (67% vs 69%). Main limitations were the short follow-up and inclusion of patients uniquely undergoing RC. CONCLUSIONS: These results suggest that ureteral DJS does not increase the risk of developing UUT recurrence in BCa patients with hydronephrosis requiring UUT decompression. However, UUT recurrence was rare, and associations were weak, with findings susceptible to bias. Randomized trials are needed to validate these results.

Clinica Luganese Moncucco Lugano Switzerland; Sant'Anna Clinic Swiss Medical Group Sorengo Switzerland

Department of Maternal Infant and Urologic Sciences Sapienza University Umberto 1 Polyclinic Hospital Rome Italy

Department of Urology and Oncologic Urology Wrocław Medical University Wroclaw Poland

Department of Urology Careggi Hospital University of Florence Florence Italy

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna General Hospital Vienna Austria

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna General Hospital Vienna Austria; Department of Urology University of Texas Southwestern Dallas TX; Karl Landsteiner Institute of Urology and Andrology Vienna Austria; Department of Urology Weill Cornell Medical College New York NY; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Luzerner Kantonsspital Lucerne Switzerland

Department of Urology Medical University of Innsbruck Innsbruck Austria

Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands

Department of Urology Puigvert Foundation Autonomous University of Barcelona Barcelona Spain

Department of Urology Spedali Civili Hospital University of Brescia Brescia Italy

Department of Urology University of Tor Vergata Rome Italy

Department of Urology UROSUD La Croix Du Sud Hospital Quint Fonsegrives France

Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS Ospedale San Raffaele Milan Italy

Division of Urology Department of Surgical Sciences Torino School of Medicine Turin Italy

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