No previous study quantified the survival outcomes of second-look ureteroscopy (SU). We hypothesized that patients who underwent SU might exhibit better survival outcomes than their no-SU counterparts.
We relied on a multicenter retrospective database including 358 patients with UTUC treated conservatively between 2010 and 2021. Endpoints, namely overall survival (OS) and radical nephroureterectomy (RNU) rates, modeled as competing event for other-cause mortality (OCM), were quantified. Cancer-specific mortality (CSM), and OCM were also quantified according to SU. Inverse probability of treatment weighting (IPTW) methodology was used to assess OS. Landmark analysis for OS at 2 mo was also performed.
Based on a median follow-up of 32 mo (interquartile range 16-56), 291 patients with UTUC were identified. Of those, 148 (51%) underwent SU. Median OS in patients who underwent SU was 103 versus 66 mo in patients without SU (D = 37 mo; p = 0.0024). RNU rates did not differ among the groups (24 vs 21%, p = 0.8). In IPTW-adjusted multivariable Cox regression models, adjusted number of lesions, tumor size, age, UTUC site, Charlson Comorbidity Index, high-grade, cytology, and ureteroscopy indication, SU patients were associated with higher OS rates compared to those without SU (hazard ratio 0.59, 95% confidence interval 0.37-0.94; p = 0.02). Within tumor ≤10 mm, four (3%) UTUC recurred in the first 9 mo of follow-up.
Within the current study, SU ensured an optimal clinical decision-making. Specifically, CSM and OCM rates of SU patients and their counterparts not receiving SU validated the patients with UTUC selection for conservative treatment.
European urology open science. 2026 Apr 27*** epublish ***
Andrea Gallioli, Francesco Di Bello, Ekaterina Laukhtina, David D'Andrea, Paolo Beltrami, Francesco Gabriele Celso, Wojciech Krajewski, Luca Afferi, Francesco Soria, Gautier Marcq, Francesco Del Giudice, Elisa De Lorenzis, Marco Moschini, Andrea Mari, José Daniel Subiela, Micheal Baboudjian, Giulio Avesani, Angelo Territo, Giuseppe Basile, Lucía Diéguez, Paula Izquierdo, Joan Palou, Benjamin Pradere, Alberto Breda, European Association of Urology Young Academic Urologists of Urothelial Working Group and Ureteroscopic Treatment of upper tract Urothelial Carcinoma (UTUC) Registry
Fundació Puigvert, Urology, Barcelona, Spain., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy., Wroclaw Medical University, Minimally Invasive and Robotic Urology, Wroclaw, Poland., Luzerner Kantonsspital, Urology, Luzern, Switzerland., University of Turin and Città della Salute e della Scienza, Surgical Sciences, Turin, Italy., Claude Huriez Hospital, Urology, Lille, France., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy., IRCCS San Raffaele Hospital, Urology, Milan, Italy., University of Florence and Careggi Hospital, Urological Robotic Surgery and Renal Transplantation Florence, Italy., Hospital Universitario Ramón y Cajal IRYCIS Universidad de Alcalá, Urology, Madrid, Spain., Department of Urology, APHM, North Academic Hospital, Marseille, France., Urosud La Croix du Sud Hospital, Urology, Quint Fonsegrives, France.