Perioperative and Oncologic Outcomes Associated with Simultaneous Radical Cystectomy and Nephroureterectomy

Published:November 24, 2022DOI:


      To compare the perioperative and oncologic outcomes associated with RCNU to a matched cohort undergoing RC alone. Simultaneous radical cystectomy and nephroureterectomy (RCNU) for synchronous upper tract and bladder urothelial carcinoma is an uncommon procedure. Sparse literature exists comparing outcomes in patients treated with radical cystectomy (RC) alone versus RCNU.


      Adults treated with RCNU for urothelial carcinoma of the bladder (UCB) and upper tract urothelial carcinoma (UTUC) between 1980 and 2020 were identified. Patients were matched 2:1 to patients undergoing RC alone for UCB based on age (+/- 5 years), gender, BMI (+/- 5), Charlson Comorbidity Index, pathologic staging (stage ≤pT2 vs >pT2), and receipt of neoadjuvant chemotherapy. Outcomes included overall survival (OS), recurrence free survival (RFS), cancer specific survival (CSS), 30-day complications, length of stay (LOS), operative time, and estimated blood loss (EBL).


      A total of 39 patients undergoing RCNU were identified and matched to 74 patients undergoing RC. There were no significant differences in LOS, EBL, or 30-day complication rates. Operative time was significantly longer in the RC cohort. OS (HR 0.58, CI 0.35-0.97, P = .036) was significantly better for patients undergoing RC alone, while no significant difference was noted in RFS (HR 0.65, 0.34-1.24) and CSS (HR 0.58, CI 0.31-1.08, P = .08).


      Patients undergoing RCNU had significantly lower OS compared to a matched group of patients undergoing RC alone. Perioperative outcomes between the groups did not differ significantly. This data can inform patient counseling for treatment of this rare disease state.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Siegel RL
        • Miller KD
        • Fuchs HE
        • Jemal A.
        Cancer statistics, 2022.
        Ca Cancer J clin. 2022; 72: 7-33
        • Chang SS
        • Boorjian SA
        • Chou R
        • et al.
        Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline.
        J Urol. 2016; 196: 1021-1029
        • Chang SS
        • Bochner BH
        • Chou R
        • et al.
        Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline.
        J Urol. 2017; 198: 552-559
        • Rouprêt M
        • Babjuk M
        • Compérat E
        • et al.
        European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2017 Update.
        Eur Urol. 2018; 73: 111-122
        • Novara G
        • Catto JW
        • Wilson T
        • et al.
        Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy.
        Eur Urol. 2015; 67: 376-401
      1. Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing open radical cystectomy and robotassisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol; 2015;67:1042.

        • Parekh DJ
        • Reis IM
        • Castle EP
        • et al.
        Robot assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial.
        Lancet. 2018; 391: 2525
        • Llorente C
        • Guijarro A
        • Hernandez V
        • Fernández-Conejo G
        • Perez-Fernandez E
        • Pocock S.
        Effect of hospital volume on 90-day mortality after radical cystectomy for bladder cancer in Spain.
        World J Urol. 2020; 38: 1221-1228
        • Quek ML
        • Stein JP
        • Daneshmand S
        • et al.
        A critical analysis of perioperative mortality from radical cystectomy.
        J Urol. 2006; 175: 886-889
        • Woldu SL
        • Sanli O
        • Clinton TN
        • Lotan Y.
        Validating the predictors of outcomes after radical cystectomy for bladder cancer.
        Cancer. 2019; 125: 223-231
        • Cosentino M
        • Palou J
        • Gaya JM
        • Breda A
        • Rodriguez-Faba O
        • Villavicencio-Mavrich H.
        Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma.
        World J Urol. 2013; 31: 141-145
        • Clavien PA
        • Barkun J
        • de Oliveira ML
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Yajima S
        • Nakanishi Y
        • Matsumoto S
        • Tanabe K
        • Masuda H.
        Simultaneous laparoscopic nephroureterectomy and robot-assisted radical cystectomy: Lessons learned from our initial experience.
        Curr Urol. 2021; 15: 193-197
        • Petruţ B
        • Coman RA
        • Hârdo V
        • Coste B
        • Maghiar T.
        Laparoscopic radical cystectomy and nephroureterectomy en bloc resection with lomboaortic and pelvic lymph node dissection.
        Med Pharm Rep. 2020; 93: 390-395
        • Buse S
        • Alexandrov A
        • Mazzone E
        • Mottrie A
        • Haferkamp A.
        Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy.
        BMC Urol. 2021; 21: 73
        • Carpinito GP
        • Cook GS
        • Tverye AN
        • et al.
        Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: a single-institution series.
        Can Urol Assoc J. 2022; 16: E363-E369
        • Pang KH
        • Groves R
        • Venugopal S
        • Noon AP
        • Catto JWF.
        Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy.
        Eur Urol. 2018; 73: 363-371
        • Deliveliotis C
        • Papatsoris A
        • Chrisofos M
        • Dellis A
        • Liakouras C
        • Skolarikos A.
        Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit?.
        Urology. 2005; 66: 299-304
        • Korkes F
        • Fernandes E
        • Gushiken FA
        • et al.
        Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: a systematic review.
        Int Braz J Urol. 2022; 48: 18-30
        • Arman T
        • Mher B
        • Varujan S
        • Sergey F
        • Ashot T.
        Health-related quality of life in patients undergoing radical cystectomy with modified single stoma cutaneous ureterostomy, bilateral cutaneous ureterostomy and ileal conduit.
        Int Urol Nephrol. 2020; 52: 1683-1689
        • Longo N
        • Imbimbo C
        • Fusco F
        • et al.
        Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy.
        BJU Int. 2016; 118: 521-526
        • Faraj KS
        • Mi L
        • Eversman S
        • Singh R
        • et al.
        The effect of urinary diversion on long-term kidney function after cystectomy.
        Urol Oncol. 2020; 38 (e15-21): 796
        • Jin XD
        • Roethlisberger S
        • Burkhard FC
        • Birkhaeuser F
        • Thoeny HC
        • Studer UE.
        Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution.
        Eur Urol. 2012; 61: 491-497
        • Syed-Ahmed M
        • Narayanan M.
        Immune Dysfunction and Risk of Infection in Chronic Kidney Disease.
        Adv Chronic Kidney Dis. 2019; 26: 8-15
        • Chen CS
        • Li JR
        • Yang CK
        • et al.
        Significant predictors of contralateral upper tract recurrence after radical nephroureterectomy for upper tract urothelial carcinoma.
        Int J Urol. 2022; 29: 69-75
        • Dominguez-Escrig JL
        • Peyronnet B
        • Seisen T
        • et al.
        Potential Benefit of Lymph Node Dissection During Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the European Association of Urology Guidelines Panel on Non-muscle-invasive Bladder Cancer.
        Eur Urol Focus. 2019; 5: 224-241
        • Dong F
        • Xu T
        • Wang X
        • et al.
        Lymph node dissection could bring survival benefits to patients diagnosed with clinically node-negative upper urinary tract urothelial cancer: a population-based, propensity score-matched study.
        Int J Clin Oncol. 2019; 24: 296-305
        • Lenis AT
        • Donin NM
        • Faiena I
        • et al.
        Role of surgical approach on lymph node dissection yield and survival in patients with upper tract urothelial carcinoma.
        Urol Oncol. 2018; 36 (9.e1-9)
        • Rouprêt M
        • Babjuk M
        • Burger M
        • et al.
        European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update.
        Eur Urol. 2021; 79: 62-79