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Objective <p>To evaluate the impact of immediate single dose intravesical instillation after operation on bladder recurrence in upper tract urothelial carcinoma patients after radical nephroureterectomy.</p> Methods <p>A retrospective analysis was performed on clinical data of upper tract urothelial carcinoma patients who underwent radical nephroureterectomy at our center from December 2013 to December 2023. All patients undergo single-dose intravesical instillation (The instillation agent were pirarubicin or epirubicin) after surgery. Patients were divided into two groups based on the time of undergoing single dose postoperative intravesical instillation: the immediate instillation group (within 24&#xa0;h after the operation) and the delayed group (2-10days after the operation). The primary observation indicator was postoperative bladder recurrence-free survival. Baseline characteristics of the two groups were balanced using propensity score matching (PSM). The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was applied to compare differences between groups. Cox proportional hazards regression model was used to analyze risk factors for postoperative bladder recurrence.</p> Results <p>A total of 418 patients were included (115 in the immediate instillation group and 303 in the delayed instillation group). After propensity score matching (PSM), 101 patients were successfully matched in each group. The 2-year bladder recurrence-free survival rate was significantly higher in the immediate instillation group (84.2%) than in the delayed instillation group (77.2%, <i>P</i> = 0.004). Subgroup analysis showed: among patients who underwent preoperative ureteroscopy, the bladder recurrence-free survival rate was 76.7% in the immediate instillation group vs. 48.0% in the delayed instillation group (<i>P</i> = 0.035); among patients without preoperative ureteroscopy, the bladder recurrence-free survival rate was 87.3% in the immediate instillation group vs. 73.7% in the delayed instillation group (<i>P</i> = 0.029). There was no difference in instillation-related adverse events between the two groups.</p> Conclusion <p>Whether ureteroscopy is performed preoperatively or not, a single immediate bladder instillation after operation can effectively reduce the bladder recurrence rate in upper tract urothelial carcinoma patients after radical nephroureterectomy compared with delayed instillation.</p>

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Immediate Vs. Delayed single post-operative intravesical instillation of chemotherapy in reducing bladder recurrence rate in upper tract urothelial carcinoma patients after radical nephroureterectomy

  • 期刊论文

  • 发表日期：

    2026年3月8日

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  • Yiwen Liu,
  • Yun Song,
  • Nienie Qi,
  • Chong Han,
  • Meng Lu,
  • Meng Zhang,
  • Rumin Wen,
  • Xiaoxiao Jiang,
  • Hailong Li

摘要

Objective

To evaluate the impact of immediate single dose intravesical instillation after operation on bladder recurrence in upper tract urothelial carcinoma patients after radical nephroureterectomy.

Methods

A retrospective analysis was performed on clinical data of upper tract urothelial carcinoma patients who underwent radical nephroureterectomy at our center from December 2013 to December 2023. All patients undergo single-dose intravesical instillation (The instillation agent were pirarubicin or epirubicin) after surgery. Patients were divided into two groups based on the time of undergoing single dose postoperative intravesical instillation: the immediate instillation group (within 24 h after the operation) and the delayed group (2-10days after the operation). The primary observation indicator was postoperative bladder recurrence-free survival. Baseline characteristics of the two groups were balanced using propensity score matching (PSM). The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was applied to compare differences between groups. Cox proportional hazards regression model was used to analyze risk factors for postoperative bladder recurrence.

Results

A total of 418 patients were included (115 in the immediate instillation group and 303 in the delayed instillation group). After propensity score matching (PSM), 101 patients were successfully matched in each group. The 2-year bladder recurrence-free survival rate was significantly higher in the immediate instillation group (84.2%) than in the delayed instillation group (77.2%, P = 0.004). Subgroup analysis showed: among patients who underwent preoperative ureteroscopy, the bladder recurrence-free survival rate was 76.7% in the immediate instillation group vs. 48.0% in the delayed instillation group (P = 0.035); among patients without preoperative ureteroscopy, the bladder recurrence-free survival rate was 87.3% in the immediate instillation group vs. 73.7% in the delayed instillation group (P = 0.029). There was no difference in instillation-related adverse events between the two groups.

Conclusion

Whether ureteroscopy is performed preoperatively or not, a single immediate bladder instillation after operation can effectively reduce the bladder recurrence rate in upper tract urothelial carcinoma patients after radical nephroureterectomy compared with delayed instillation.