The effect of ureteral stenting on the risk of metachronous upper tract urothelial carcinoma in patients with bladder tumors involving the ureteral orifice

Abstract Background Ureteral stenting in patients with bladder cancer involving the ureteral orifice may increase the rate of metachronous upper tract urothelial carcinoma (UTUC). Nevertheless, evidence on the matter is scarce and often contradictory. Materials and methods We performed an observational study comparing ureteral stenting versus no stenting with respect to the risk of developing metachronous UTUC in patients who underwent transurethral resection of bladder tumors (TURBT) involving the ureteral orifice between January 2015 and December 2024. We performed time-to-event analyses to estimate hazard ratios (HRs) along with their corresponding 95% confidence intervals (CIs). Results We included 151 patients with a median age of 73 years. 37 (25%) underwent ureteral stenting during TURBT. Patients undergoing stenting had higher BMI ( p = 0.014), more aggressive tumors ( p = 0.003), underwent prior intravesical therapy more often ( p = 0.008), higher preoperative creatinine values ( p = 0.007), and longer hospitalization duration ( p = 0.002) compared to those who did not undergo stenting. After a median follow-up of 25 months, 8 patients developed metachronous UTUC (2 in the stenting group and 6 in the non-stenting group). Ureteral stenting was not associated with statistically significantly higher rates of metachronous UTUC (HR: 1.2, 95%CI: 0.31–5.6, p > 0.9). During follow-up, 49 (33%) patients developed recurrence in the bladder, 43 (28%) underwent cystectomy, and 24 (16%) died. The HRs did not significantly differ between the two groups. Conclusions The present study did not demonstrate an increased risk of metachronous UTUC after stenting during TURBT with urothelial cancer involving the ureteral orifice. Moreover, stenting was not statistically significantly associated with increased recurrences in the urinary bladder, higher cystectomy rates, or worse mortality.