Does ureteral stent drainage prior to cystectomy increase the risk of subsequent upper tract urothelial carcinoma and ureteral complications

ABSTRACT Objectives To guide management of preoperative hydronephrosis prior to radical cystectomy (RC), we compared post-RC risks of upper tract urothelial carcinoma (UTUC) and ureteroenteric anastomotic complications between ureteral stent and percutaneous nephrostomy tube drainage. Methods Patients who underwent RC for urothelial carcinoma without a prior diagnosis of UTUC at our institution between 2000-2015 were included and divided into four patient groups: 1) no hydronephrosis (75%, N=787); 2) hydronephrosis without preoperative upper tract drainage (13%, N=132); 3) hydronephrosis treated with nephrostomy tube (3%, N=36); 4) hydronephrosis treated with ureteral stent (9%, N=94). The incidence of post-RC UTUC and ureteral complications was compared using Kaplan-Meier analyses and multivariable Cox proportional hazard modeling. Results We identified a total of 1049 patients who underwent RC (median postoperative follow up 4.3 years). Five-year post-RC UTUC incidence was 6.6%, 10.2%, 17%, 18.7% for groups 1-4, respectively (p=0.13). On multivariable analysis, nephrostomy tube drainage (HR 4.10, P=0.02) and preoperative ureteral stenting (HR 2.35, P=0.04) were both associated with UTUC after RC, but ureteral stenting did not have a significantly higher association with UTUC than nephrostomy tube drainage. Severe hydronephrosis was also associated with development of UTUC (HR 4.03, P=0.02). The incidence of ureteroenteric anastomotic complications did not vary by drainage modality. Conclusions Pre-operative hydronephrosis was associated with UTUC after RC, but ureteral stent placement did not increase the risk of UTUC or ureteral complications relative to nephrostomy tube placement. The choice of hydronephrosis drainage pre-RC should not be guided by concern for UTUC risk.