POL Scientific / Bladder / Volume 11 / Issue 1 / DOI: 10.14440/bladder.2024.0007
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PERSPECTIVE ARTICLE

Strategies to reduce bladder tumor recurrences following surgery for upper tract urothelial carcinoma

Dennis J. Head1 ,  Jay D. Raman1*
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1 Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, United States of America
Bladder 2024 , 11(1), e21200001; https://doi.org/10.14440/bladder.2024.0007
Submitted: 12 June 2024 | Revised: 2 July 2024 | Accepted: 8 July 2024 | Published: 31 July 2024
© 2024 by the Bladder published by POL Scientific. Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

The incidence of upper tract urothelial carcinoma (UTUC) has been on the rise and the malignancy is more commonly managed surgically as higher proportions of in situ disease are being detected. One challenge facing urologists is the high rate of post-treatment intravesical recurrence (IVR) of UTUC (23 – 50%). Genomic research indicated that cells of recurrent bladder lesions are most often clonally derived from the primary UTUC and are likely to seed into the bladder after tumor manipulation. This calls for effective strategies to prevent the spread of UTUC. The methods we discuss here are the use of a ureteral access sheath during diagnostic ureteroscopy, application and timing of intravesical chemoprophylaxis, early ureteral ligation distal to UTUC, and formal bladder cuff excision. Urologic surgeons should aim to achieve a reduced rate of IVR when applying these techniques.

Keywords
Chemoprophylaxis
Nephroureterectomy
Ureteroscopy
Funding
This study is supported by The Ken and Bonnie Shockey Fund for Urologic Oncology Research at Penn State Health (grant no.: 3112410001).
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Conflict of interest
The authors declare no conflicts of interest.
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