Endoscopic management of upper urinary tract urothelial carcinoma: oncologic outcomes and prognostic factors in a contemporary cohort

Appropriate risk stratification and complete tumour ablation are the key factors to optimise the oncologic outcomes of patients undertaking endoscopic management for the upper urinary tract urothelial carcinoma (UTUC). We aimed to identify risk factors associated to tumour recurrence and progression in a contemporary cohort of patients diagnosed and treated with the latest endourological technologies. Forty-seven patients were selected between January-2015 and March-2019 for an endoscopic management of UTUC. Last generation of digital ureteroscopes with image-enhancing technologies were employed for the detection of the lesions. The retrograde approach was the most frequent access (n=45/47). The confocal laser endomicroscopy and multiple biopsy devices were variably used according to site and tumour presentation for their characterization. Holmium and Thulium lasers were variably employed, with their combination being the preferred approach in case of larger lesions. Primary endpoints included the identification of factors associated with UTUC recurrence and progression, and bladder tumour recurrence. Median FU was 24 months (IQR 17-44). On multivariate analysis, BC recurrence was associated to previous contralateral UTUC (HR:5,08[95% CI:1,35-18,94], p