Background: Whether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT) harms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development remains controversial. This study evaluated the impact of DJ compared to nephrostomy placement during TURBT for bladder cancer (BCa) on the incidence of metachronous UUTUCs. Methods: We retrospectively analysed 637 patients who underwent TURBT in our department between 2008 and 2016. BCa, UUTUC and urinary drainage data (retrograde/anterograde DJ and percutaneous nephrostomy) were assessed, along with the prevalence of hydronephrosis, and mortality. Chi-square and Fisher's exact test was performed for univariate analyses. Survival analysis was performed by the Kaplan-Meier method and log-rank tests.< Results: UUTUC was noted in 28 out of 637 patients (4.4%), whereas only eight (1.3%) developed it metachronously to BCa. Out of these, four patients received DJ stents, while four patients received no urinary drainage of the upper urinary tract. Placement of urinary drainage significantly correlated with UUTUC (50.0% vs. 17.9%; p = 0.041). DJ stenting significantly correlated with UUTUC (50.0% vs. 11%; p <  0.01), while no patient with a nephrostomy tube developed UUTUC. UUTUC-free survival rates were significantly lower for patients with DJ stents than for all other patients (p = 0.001). Patients with or without DJ stents had similar overall survival (OS) rates (p = 0.73), whereas patients with nephrostomy tubes had significantly lower OS rates than all other patients (p <  0.001). Conclusions: Patients with DJ stenting during TURBT for BCa might have an increased risk of developing metachronous UUTUC. This study indicated advantages in placing nephrostomy tubes rather than DJ stents; however, confirmation requires investigation of a larger cohort. Even so, the increased mortality rate in the nephrostomy group reflected hydronephrosis as an unfavourable prognostic factor.

Keywords:
Upper urinary tract urothelial cancer, Double J stent, Nephrostomy, Transurethral resection of bladder tumour

Hintergrund

Gründe für die Instrumentation des oberen Harntraktes während der transurethralen Resektion eines Blasentumors (TURB) sind vielfältig. Nephrostomien werden meistens zur Entlastung einer Hydronephrose eingelegt, während DJ-Harnleiterschienen auch bei Ostium-nahen Resektionen oder Überresektionen des Ostiums zur Prävention einer Obstruktion respektive Harnstauungsniere eingelegt werden. Welchen Einfluss die Methode der Instrumentation des oberen Harntraktes während der TURB auf die Inzidenz des metachronen Urothelkarzinoms des oberen Harntraktes hat, wurde von Hupe und Kollegen retrospektiv an 637 Patienten untersucht (Abbildung 1).

Ergebnisse der Studie

Insgesamt war die Inzidenz des Urothelkarzinoms des oberen Harntraktes mit 4,4 Prozent gering, nur bei 8 Patienten bzw. 1,3 Prozent tratender metachrone Karzinome auf. Von diesen 8 Patienten erhielten 4 eine DJ-Harnleiterschienung, bei den übrigen 4 Patienten war keine Instrumentation des oberen Harntraktes notwendig. Somit korrelierte das metachrone Auftreten eines Urothelkarzinoms des oberen Harntraktes in diesem Kollektiv statistisch signifikant mit der Einlage einer DJ-Harnleiterschiene während der TURB, da bei keinem der Patienten mit Nephrostomie ein metachrones Karzinom im oberen Harntrakt zu verzeichnen war.

Fazit für die Praxis

Zusammenfassend ist es laut der Autoren vorteilhaft, während der TURB eine Nephrostomie anstelle einer DJ-Harnleiterschiene zur Prävention von Urothelkarzinomen des oberen Harntraktes einzulegen. Auch wenn die geringe Studienpopulation eine Limitation darstellt, stehen die Daten im Einklang mit bereits publizierten Erfahrungen an ähnlichen Patientenkollektiven. Die Daten unterstreichen die äußerst zurückhaltende Indikationsstellung zur DJ-Harnleiterschienung bei Urothelkarzinomen der Harnblase, um eine Verschleppung von Tumorzellen in den oberen Harntrakt zu vermeiden.

Der Autor hat keine Angaben zu Interessenkonflikten gemacht.

© The Authors, 2020
2020
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