Cumulative morbidity of ureteroscopy for upper tract urothelial carcinoma

G Basile; A Gallioli; A Territo; P Verri; J M Gaya; L Afferi; P Diana; I Sanz; L Dieguez; A Uleri; C Berquin; P Gavrilov; F Algaba; J Palou; A Breda

doi:10.1016/j.acuroe.2024.05.007

Cumulative morbidity of ureteroscopy for upper tract urothelial carcinoma

Actas Urol Esp (Engl Ed). 2024 May 10:S2173-5786(24)00067-2. doi: 10.1016/j.acuroe.2024.05.007. Online ahead of print.

[Article in English, Spanish]

Authors

G Basile¹, A Gallioli², A Territo², P Verri³, J M Gaya², L Afferi², P Diana², I Sanz², L Dieguez², A Uleri⁴, C Berquin⁵, P Gavrilov², F Algaba⁶, J Palou², A Breda²

Affiliations

¹ Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, IRCCS Hospital San Raffaele, Milán, Italy. Electronic address: g.basile0984@gmail.com.
² Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
³ Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, Universidad de Turín, Turín, Italy.
⁴ Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, Universidad Humanitas, Rozzano, Milán, Italy.
⁵ Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, Hospital Universitario de Gante, Bélgica, Centro acreditado en la Red Europea de Referencia (ERN) eUROGEN, Belgium.
⁶ Área de Anatomía Patológica, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.

PMID: 38735432
DOI: 10.1016/j.acuroe.2024.05.007

Abstract

Objective: To assess complications after ureteroscopy (URS) for upper tract urothelial carcinoma (UTUC) management and to assess its postoperative cumulative morbidity burden using the Comprehensive Complication Index (CCI).

Materials and methods: Single center retrospective study including patients submitted to URS for UTUC suspicion. URSs were both diagnostic and operative. Postoperative complications were recorded according to the EAU Guidelines and graded according to Clavien-Dindo Classification (CDC). The cumulative postoperative morbidity burden developed by patients experiencing multiple events was assessed using the CCI. Multivariable logistic regression (MLR) analyses identified factors independently associated with the development of any grade and major postoperative complications.

Results: Overall, 360 patients with UTUC suspicion were included with a total of 575 URSs performed. The cumulative number of all postoperative complications recorded was 111. In 86 (15%) procedures, patients experienced at least one postoperative complication, while 25 (4.3%) experienced more than one complication. Of these, 16 (14%) were severe (CDC ≥ IIIa). The most frequent type of complications were urinary (34%), bleeding (30%) and infectious (30%). The higher the CDC grade, the higher the median CCI, with a statistically significant increase in median CCI from CDC II to major complications. Patients who experienced intraoperative complications were at higher risk of developing any grade and major postoperative complications at MLR.

Conclusions: Complications after ureteroscopy for UTUC are relatively uncommon events. Patients who experience intraoperative complications are at higher risk of developing postoperative complications. The comprehensive complication index appeared more representative of the cumulative postoperative morbidity rather than the Clavien-Dindo classification.

Keywords: Carcinoma urotelial del tracto superior; Complicación; Complication; Morbidity; Morbilidad; Upper tract urothelial carcinoma; Ureteroscopia; Ureteroscopy.