Background: Although previous literature shows tumor location as a prognostic factor in upper tract urothelial carcinoma (UTUC), there remains uninvestigated regarding the impact of tumor location on grade concordance and discrepancies between ureteroscopic (URS) biopsy and final radical nephroureterectomy (RNU) pathology. Methods: In this international study, we retrospectively reviewed the records of 1,498 patients with UTUC who underwent diagnostic URS with concomitant biopsy followed by RNU between 2005 and 2020. Tumor location was divided into four sections: the calyceal-pelvic system, proximal ureter, middle ureter, and distal ureter. Patients with multifocal tumors were excluded from the study. We performed multiple comparison tests and logistic regression analyses. Results: Overall, 1,154 patients were included; 54.4% of those with low-grade URS biopsies were upgraded on RNU. In the multiple comparison tests, middle ureter tumors exhibited the highest probability of upgrading, meanwhile pelvicalyceal tumors exhibited the lowest probability of upgrading (73.7% vs 48.5%, p = 0.007). Downgrading was comparable across all tumor locations. On multivariate analyses, middle ureteral location was significantly associated with a low probability of grade concordance (odds ratio [OR] 0.59; 95% confidence interval [CI], 0.35-1.00; p = 0.049) and an increased risk of upgrading (OR 2.80; 95% CI, 1.20-6.52; p = 0.017). The discordance did not vary regardless of caliceal location, including the lower calyx. Conclusions: Middle ureteral tumors diagnosed to be low grade had a high probability to be undergraded. Our data can inform providers and their patients regarding the likelihood of undergrading according to tumor location, facilitating patient counseling and shared decision making regarding the choice of kidney sparing vs RNU.

• MeSH
• biopsie MeSH
• karcinom z přechodných buněk chirurgie   patologie   MeSH
• klinická relevance MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory ledvin patologie   chirurgie   MeSH
• nádory močovodu * patologie   chirurgie   MeSH
• nefroureterektomie metody   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stupeň nádoru * MeSH
• ureter patologie   chirurgie   diagnostické zobrazování   MeSH
• ureteroskopie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

We systematically reviewed the literature and summarized oncologic and safety outcomes for endoscopic management (EM) compared to radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC). Studies comparing oncologic and/or safety results for EM versus RNU in patients with UTUC were included in our review. Overall, 13 studies met the criteria, and five studies were included in a meta-analysis using adjusted hazard ratios (HRs) for overall survival (OS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS). EM was associated similar OS (HR 1.27, 95% confidence interval [CI] 0.75-2.16), CSS (HR 1.37, 95% CI 0.99-1.91), and BRFS (HR 0.98, 95% CI 0.61-1.55) to RNU, while 28-85% of patients treated with EM experienced upper tract recurrence across the studies. EM required more interventions with a higher cumulative risk of complications and lower likelihood of renal preservation. In summary, EM for low-grade UTUC had comparable survival outcomes to RNU at the cost of higher local recurrence rates resulting in a need for long-term rigorous surveillance and repeated interventions. PATIENT SUMMARY: For selected cases of cancer in the upper urinary tract, surgical treatment via a telescope inserted through the urethra or the skin (endoscope) results in cancer control outcomes that are comparable to those after removal of the kidney and ureter. However, because of its higher rate of local recurrence, this approach requires repeated endoscopic treatment sessions. Patients should be well informed about these issues to help in shared decision-making.

• MeSH
• karcinom z přechodných buněk * chirurgie   MeSH
• lidé MeSH
• nádory močového měchýře * chirurgie   MeSH
• nefroureterektomie metody   MeSH
• ureter * chirurgie   MeSH
• ureteroskopie škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

The aim of this study was to identify and summarize available data on oncologic and safety outcomes for retrograde versus antegrade endoscopic surgery in patients with upper tract urothelial carcinoma (UTUC). We systematically searched studies reporting on endoscopic surgery in patients with UTUC. The primary outcome of interest was oncologic control, including bladder and upper urinary tract recurrences. The secondary outcomes were any-grade and major complications. Twenty studies comprising 1091 patients were included in our analysis. The pooled bladder recurrence rate was 35% (95% confidence interval [CI] 28.0-42.3%; I2 = 48%) after retrograde endoscopic surgery and 17.7% (95% CI 6.5-32.1%; I2 = 29%) after antegrade endoscopic surgery. The pooled upper urinary tract recurrence rate was 56.4% (95% CI 41.2-70.9; I2 = 93%) after retrograde endoscopic surgery and 36.2% (95% CI 25.5-47.6%; I2 = 57%) after antegrade endoscopic surgery. The pooled complication rate was 12.5% (95% CI 0.8-32.8%; I2 = 94%) for any-grade complications and 6.6% (95% CI 0.1-19.1%; I2 = 89%) for major complications in the retrograde endoscopic cohort. In summary, our analyses suggest promising oncologic benefits of antegrade kidney-sparing surgery in terms of bladder and upper urinary tract recurrence rates in UTUC. Retrograde endoscopic surgery is a safe procedure with a minimal risk of complications and acceptable oncologic outcomes. Research should address the hypothesis that endoscopic antegrade surgery can be a safe and effective alternative for well-selected patients. PATIENT SUMMARY: One of the surgical options for treatment of cancer of the upper urinary tract is removal of the tumor through a small telescope called an endoscope. The endoscope can be inserted via the urethra (called a retrograde approach) or through a small incision in the skin (antegrade approach). Our review shows that the antegrade approach seems to provide acceptable cancer control rates. Further research could help to identify the role for endoscope surgery in cancer of the upper urinary tract.

• MeSH
• karcinom z přechodných buněk * chirurgie   patologie   MeSH
• lidé MeSH
• nádory ledvin * chirurgie   patologie   MeSH
• nádory močového měchýře * MeSH
• nádory močovodu * chirurgie   patologie   MeSH
• ureteroskopie škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

OBJECTIVES: Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. METHODS: Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. RESULTS: This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (≥pT2) compared to low-grade biopsy. CONCLUSIONS: High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.

• MeSH
• biopsie MeSH
• karcinom z přechodných buněk * patologie   MeSH
• lidé MeSH
• nádory močového měchýře * chirurgie   MeSH
• nádory močovodu * chirurgie   patologie   MeSH
• nefroureterektomie MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• ureteroskopie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Urolitiáza je celosvětově rozšířeným onemocněním močového systému, které postihuje všechny věkové skupiny. V posledních několika desetiletích prevalence urolitiázy celosvětově narůstá a představuje závažný nejen medicínský, ale i sociálně ekonomický problém. Vzhledem k technologickému vývoji během posledních dvou desetiletí se ureteroskopická litotrypse stala celosvětově běžnou metodou léčby kamenů horních močových cest. Jedná se o velmi účinnou a minimálně invazivní metodu. Během endoskopického výkonu však může dojít k poranění ureteru, a to má za následek snížení peristaltiky v místě inzultu, stimulaci ureterální hypertrofie a iniciování zjizvení ve svalové vrstvě ureterální stěny, což má za následek vznik striktury. Samotná striktura může bránit normálnímu toku moči, která vede k hydronefróze, zjizvení ledvinového parenchymu, snížení funkce ledviny a u některých pacientů může dokonce vyvolat trvalou ztrátu renálních funkcí.

Urolithiasis is a globally widespread disease of the urinary system affecting all age groups. In the last few decades, the prevalence of urolithiasis has been increasing worldwide and represents a serious medical but also a socioeconomic problem. Due to technological developments during the last two decades, ureteroscopic lithotripsy become a common method of treatment for upper urinary tract stones worldwide. It is a very effective and minimally invasive method. However, during an endoscopic procedure, injury to the ureter can occur which results in decreased peristalsis at the site of the insult, stimulation of ureteral hypertrophy, and initiation of scarring in the muscle layer of the ureteral wall, which leads to the formation of a stricture. The stricture itself can obstruct the normal flow of urine, resulting into hydronephrosis, scarring of renal parenchyma, decreased kidney function, and in some patients can even cause permanent loss of renal function.

• MeSH
• incidence MeSH
• lidé MeSH
• rizikové faktory MeSH
• striktura uretry * etiologie   patofyziologie   MeSH
• ureteroskopie škodlivé účinky   MeSH
• urolitiáza * chirurgie   terapie   MeSH
• Check Tag
• lidé MeSH

PURPOSE: We sought to determine which treatment between flexible ureteroscopy and shock wave lithotripsy has a better stone-free rate in pediatric patients (<18 years) with renal or proximal ureteric stones (<2 cm). Subanalysis for all outcomes for randomized controlled trials only. MATERIALS AND METHODS: Using PubMed, Web of Science, and the Cochrane database, we identified studies (randomized clinical trials and prospective comparative nonrandomized studies) published until August 2022 reporting surgical outcomes of pediatrics patients undergoing flexible ureteroscopy and shock wave lithotripsy with renal or proximal ureteric stones <2 cm (PROSPERO ID: CRD42022378790). Only randomized controlled trials were considered for meta-analysis. Stone-free rate, operative time, and complications were analyzed. Analysis was performed in R. RESULTS: A total of 6 studies identified, of which 3 were randomized clinical trials and 4 had data on renal stones. A total of 669 patients were analyzed. Mean age ranged from 4.4 to 12.4 years. The shock wave lithotripsy group presented a range of stone-free rate between 21 and 90% while the flexible ureteroscopy group presented a range of stone-free rates between 37% and 97%. Meta-analysis of randomized controlled trials only (n=302) demonstrated significantly higher stone-free rate in flexible ureteroscopy vs shock wave lithotripsy (RR = 1.17, 95% CI: 1.04-1.33, P = 0.01), operative time (mean difference = +16.4 minutes, 95% CI: 7.3-25.5, P < 0.01) and hospital stay (mean difference = +0.25 days, 95% CI: 0.14-0.36, P < 0.001). But no difference in fluoroscopy exposure time (mean difference = -21.0 seconds, 95% CI: -42.6 to 0.56, P = 0.07), Clavien I-II (RR = 1.23, 95% CI: 0.71-2.12, P = 0.45) or Clavien III-V complications (RR = 1.04, 95% CI: 0.32-3.42, P = 0.95). CONCLUSIONS: Flexible ureteroscopy has a significantly higher stone-free rate than shock wave lithotripsy, with no difference in complication rate or fluoroscopy exposure time, and significantly higher operative times and hospital stay. However, the current evidence base for this is weak and further randomized trials are needed.

• MeSH
• dítě MeSH
• kameny v močovodu * terapie   MeSH
• ledvinové kameny * terapie   etiologie   MeSH
• lidé MeSH
• litotripse * škodlivé účinky   MeSH
• močové kameny * etiologie   MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• ureteroskopie škodlivé účinky   MeSH
• urologie * MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

PURPOSE: The European Association of Urology (EAU) has updated its guidelines on clinical best practice in urolithiasis for 2021. We therefore aimed to present a summary of best clinical practice in surgical intervention for patients with upper tract urolithiasis. MATERIALS AND METHODS: The panel performed a comprehensive literature review of novel data up to May 2021. The guidelines were updated and a strength rating was given for each recommendation, graded using the modified Grading of Recommendations, Assessment, Development, and Evaluations methodology. RESULTS: The choice of surgical intervention depends on stone characteristics, patient anatomy, comorbidities, and choice. For shockwave lithotripsy (SWL), the optimal shock frequency is 1.0-1.5 Hz. For ureteroscopy (URS), a postoperative stent is not needed in uncomplicated cases. Flexible URS is an alternative if percutaneous nephrolithotomy (PCNL) or SWL is contraindicated, even for stones >2 cm. For PCNL, prone and supine approaches are equally safe. For uncomplicated PCNL cases, a nephrostomy tube after PCNL is not necessary. Radiation exposure for endourological procedures should follow the as low as reasonably achievable principles. CONCLUSIONS: This is a summary of the EAU urolithiasis guidelines on best clinical practice in interventional management of urolithiasis. The full guideline is available at https://uroweb.org/guidelines/urolithiasis. PATIENT SUMMARY: The European Association of Urology has produced guidelines on the best management of kidney stones, which are summarised in this paper. Kidney stone disease is a common condition; computed tomography (CT) is increasingly used to diagnose it. The guidelines aim to decrease radiation exposure to patients by minimising the use of x-rays and CT scans. We detail specific advice around the common operations for kidney stones.

• MeSH
• ledvinové kameny * chirurgie   komplikace   MeSH
• lidé MeSH
• perkutánní nefrostomie * metody   MeSH
• ureteroskopie metody   MeSH
• urolitiáza * chirurgie   komplikace   MeSH
• urologie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

INTRODUCTION: This study aimed to evaluate the concordance in tumor stage and grade between ureteroscopic (URS) biopsy and radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: Records of 1,214 UTUC patients who had undergone URS biopsy followed by RNU were included. Univariable and multivariable logistic regression analyses were performed to identify factors contributing to the pathological upstaging. RESULTS: The concordance between URS biopsy-based clinical and RNU pathological staging was 34.5%. Clinical understaging occurred in 59.5% patients. Upstaging to muscle-invasive disease occurred in 240 (41.7%) of 575 patients diagnosed with ≤cT1 disease. Of those diagnosed with muscle-invasive disease on final pathology, 89.6% had been clinically diagnosed with ≤cT1 disease. In the univariable analyses, computed tomography urography (CTU)-based invasion, ureter location, hydronephrosis, high-grade cytology, high-grade biopsy, sessile architecture, age, and women sex were significantly associated with pathological upstaging (P < .05). In the multivariable analyses, CTU-based invasion and hydronephrosis remained associated with pathological upstaging (P < .05). URS biopsy-based clinical and pathological gradings were concordant in 634 (54.2%) patients. Clinical undergrading occurred in 496 (42.4%) patients. CONCLUSIONS: Clinical understaging/undergrading and upstaging to muscle-invasive disease occurred in a high proportion of UTUC patients undergoing RNU. Despite the inherent selection bias, these data underline the challenges of accurate UTUC staging and grading. In daily clinical practice, URS biopsy and CTU offer the most accurate preoperative information albeit with limited predictive value when used alone. These findings should be considered when utilizing preoperative, risk-adapted strategies.

• MeSH
• hydronefróza * MeSH
• karcinom z přechodných buněk * patologie   MeSH
• lidé MeSH
• nádory močového měchýře * patologie   MeSH
• nádory močovodu * patologie   chirurgie   MeSH
• retrospektivní studie MeSH
• ureteroskopie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: The aim of this study was to investigate factors that may predict a negative ureteroscopy (URS) performed for ureteric calculi in prestented patients and to assess preoperative imaging in reducing the rate of negative URS. METHODS: Data were collected on emergency stent placement for a ureteric calculus from April 2011 to February 2016 (Group A) and October 2016 to October 2019 (Group B). Data included patient demographics, indication for a stent, stone characteristics, baseline bloods, urine culture, readmission, negative URS rate and the use of pre-URS imaging. Multivariate logistic regression was used for statistical analysis. RESULTS: Of 257 patients who underwent emergency stent insertion, 251 underwent deferred URS for a ureteric calculus and 6 avoided URS due to pre-URS imaging. Indications for stent were pain (42%), sepsis (39%) and acute kidney injury (19%). Mean stone size was 7.8mm, mean stone density was 699 Hounsfield units (HU) and the stone locations were upper (62%), mid (13%) and lower ureter (25%). The overall negative URS rate was 12%. The negative URS rate was lower in patients with pre-URS imaging compared with those with none, 6% and 14%, respectively (OR=2.33, 95% CI: 0.69-7.56, p=0.2214). Logistic regression analysis indicated stone size as the only significant predictor of a negative URS, where the greater the size of the stone the less likely URS would be negative (β=0.75, 95% CI: 0.60-0.94 p=0.011). CONCLUSIONS: Utilising pre-URS imaging can lead to a reduction in negative URS rate. Stone size <5mm appears to be the subgroup most likely to benefit from imaging.

• MeSH
• kameny v močovodu * diagnostické zobrazování   chirurgie   MeSH
• ledvinové kameny * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• močové kameny * MeSH
• retrospektivní studie MeSH
• ureter * diagnostické zobrazování   chirurgie   MeSH
• ureteroskopie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The aims of the study were to compare the change in the Wisconsin Stone Quality of Life (WISQOL) score in patients who underwent retrograde intrarenal surgery (RIRS) single-use ureteroscope or extracorporeal shock wave lithotripsy (ESWL) with a calculation of quality-adjusted life-years (QALYs). 158 patients treated with urinary stone disease were randomly divided into 80 patients in the validation and 78 patients in the intervention arm. Patients in the intervention arm were randomly divided into the RIRS or the ESWL group. Linguistic validation of the WISQOL into the Slovak language was performed using a standardised multistep process. Discriminant validity was assessed by comparing stone-forming patients to an additional 34 healthy individuals. Patients were asked to fill in the WISQOL before and in the 24th week after the intervention. The QALYs were calculated by the formula QALY = weight factor (WF) x time period after intervention. The Cronbach's α of the WISQOL was 0.94, the Pearson's coefficient for test-retest reliability was 0.91, and the discriminant validity confirmed a higher score for healthy individuals (p < 0.001). The median WISQOL score changed from 45.5 to 95.5 vs. 33.9 to 87.1 in the RIRS and ESWL groups, respectively (p < 0.001). Patients from the RIRS group had a good possibility of reaching 19.727 QALYs gained during life expectancy compared to 15.780 for the ESWL group (p < 0.001). RIRS single-use ureteroscope is significantly superior to ESWL in reaching more QALYs gained during life expectancy. The WISQOL Slovak version is valid, reliable and strictly specific for stone-forming patients.

• MeSH
• kvalita života * MeSH
• kvalitativně upravené roky života MeSH
• lidé středního věku MeSH
• lidé MeSH
• litotripse statistika a číselné údaje   MeSH
• močové kameny komplikace   psychologie   chirurgie   MeSH
• překládání MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky statistika a číselné údaje   MeSH
• psychometrie metody   MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• ureteroskopie přístrojové vybavení   statistika a číselné údaje   MeSH
• ureteroskopy MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• validační studie MeSH