Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group)

Francesco Ditonno, Antonio Franco, Alessandro Veccia, Riccardo Bertolo, Zhenjie Wu, Linhui Wang, Firas Abdollah, Marco Finati, Giuseppe Simone, Gabriele Tuderti, Emma Helstrom, Andres Correa, Ottavio De Cobelli, Matteo Ferro, Francesco Porpiglia, Daniele Amparore, Antonio Tufano, Sisto Perdonà, Raj Bhanvadia, Vitaly MargulisStephan Brönimann, Nirmish Singla, Dhruv Puri, Ithaar H. Derweesh, Dinno F. Mendiola, Mark L. Gonzalgo, Reuben Ben-David, Reza Mehrazin, Sol C. Moon, Soroush Rais-Bahrami, Courtney Yong, Chandru P. Sundaram, Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Hooman Djaladat, Riccardo Autorino, Alessandro Antonelli

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery.

MATERIALS AND METHODS: In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes.

RESULTS: Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality.

CONCLUSIONS: The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.

Original languageEnglish
Pages (from-to)290.e1-290.e9
JournalUrologic Oncology: Seminars and Original Investigations
Issue number9
StateAccepted/In press - 2024


  • Diagnostic ureteroscopy
  • Kidney-sparing surgery
  • Nephroureterectomy
  • Upper tract urothelial carcinoma
  • Prognosis
  • Humans
  • Middle Aged
  • Male
  • Carcinoma, Transitional Cell/surgery
  • Ureteral Neoplasms/surgery
  • Clinical Decision-Making
  • Female
  • Ureteroscopy/methods
  • Aged
  • Retrospective Studies
  • Kidney Neoplasms/surgery


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