The Impact of II-look Ureteroscopy on Survival in Upper Tract Urothelial Carcinoma: A Multicenter Retrospective Study of EAU-YAU Urothelial Working Group

Background and objective: 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. Methods: 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. Key findings: 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. Conclusions and clinical implications: 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.