Impact of Multiple Prostate Biopsies: Risk of Perioperative Complications and Biochemical Recurrence After Radical Prostatectomy

Purpose@#The aim of this study was to analyze the perioperative complications and oncological outcomes of radical prostatectomy (RP) in patients who underwent multiple prostate biopsies. @*Materials and Methods@#A total of 1,112 patients who underwent RP between January 2009 and April 2016 at 4 different centers were included in this study. We divided these patients into 2 groups: patients who underwent only 1st biopsy, and those who underwent 2nd or more repeated biopsies. The association between the number of prior biopsies and perioperative complications and biochemical recurrence (BCR) was analyzed. @*Results@#Of 1,112 patients, 1,046 patients (94.1%) underwent only 1st biopsy, and 66 (5.9%) underwent 2nd or more repeated biopsies. There were no significant differences in preoperative prostate-specific antigen levels, operation times, blood loss volumes, or hospital stay durations (all p＞0.05). Patients who underwent multiple prostate biopsies presented with a localized tumor significantly more often (p＜0.05). The Gleason score and rate of positive surgical margins were significantly lower in patients with multiple biopsies (all p＜0.05). The Cox proportional hazards model analysis indicated that there was no association between the number of prior prostate biopsies and BCR (p＞0.05). Kaplan-Meier curve analysis indicated that BCR-free survival rates between the 2 groups were similar (p＞0.05). @*Conclusions@#Multiple prostate biopsies are not associated with an increased risk of perioperative complications, adverse pathological outcomes, or higher rates of BCR in patients who have undergone RP. (Korean J Urol Oncol 2020;18:24-31)

A novel one lobe technique of thulium laser enucleation of the prostate: 'All-in-One' technique

PURPOSE: The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here. MATERIALS AND METHODS: From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate. RESULTS: The mean operative time was 82.1+/-33.3 minutes. The mean enucleation time and morcellation time were 52.7+/-21.7 minutes and 8.2+/-7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9+/-24.6 g and 0.4+/-0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively. CONCLUSIONS: The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.

Clinicopathologic Differences Between Prostate Cancers Detected During Initial and Repeat Transrectal Ultrasound-Guided Biopsy in Korea

PURPOSE: The aim of this study was to investigate clinicopathologic differences between prostate cancer (PCa) detected at initial and repeat transrectal ultrasound-guided prostate biopsy in a large Korean cohort. MATERIALS AND METHODS: From 2000 through 2012, a total of 7,001 patients underwent transrectal ultrasound-guided prostate biopsy at 6 centers in Daegu and Gyeongbuk provinces. Of these 7,001 patients, the initial biopsy was positive for PCa in 2,118 patients. Repeat biopsy was performed in 374 of the 4,883 patients with an initial negative finding and a persistently elevated prostate-specific antigen (PSA) level, nodules or asymmetry by digital rectal examination (DRE), high-grade prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Numbers of biopsy cores varied from 6 to 12 according to center and biopsy date. RESULTS: Cancer was diagnosed in 2,118 of the 7,001 patients (30.3%) at initial biopsy and in 86 of the 374 patients (23.0%) at repeat biopsy. The repeat biopsy rate was 5.3%. Mean PSA values were 68.7+/-289.5 ng/mL at initial biopsy and 18.0+/-55.4 ng/mL at repeat biopsy (p<0.001). The mean number of cancer-positive cores per biopsy was 5.5+/-3.5 for initial biopsy and 3.0+/-2.9 for repeat biopsy (p<0.001). Mean Gleason score was 7.5+/-1.4 at initial biopsy and 6.6+/-1.3 at repeat biopsy (p<0.001). For detected cancers, the low-stage rate was higher for repeat biopsy than for initial biopsy (p=0.001). CONCLUSIONS: Cancers detected at repeat biopsy tend to have lower Gleason scores and stages than cancers detected at initial biopsy. The present study shows that repeat biopsy is needed in patients with a persistently high PSA or abnormal DRE findings.

An Analytical Comparison of Short-term Effectiveness and Safety Between Thulium:YAG Laser Vaporesection of the Prostate and Bipolar Transurethral Resection of the Prostate in Patients With Benign Prostatic Hyperplasia

PURPOSE: In recent years, laser surgery has been widely used to treat benign prostatic hyperplasia (BPH). A thulium:yttrium-aluminium-garnet (Tm:YAG) laser was recently introduced for BPH surgery. We compared the effectiveness and safety of Tm:YAG laser vaporesection of the prostate (ThuVaRP) with that of bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS: From January 2010 to December 2012, 86 patients underwent surgical treatment for symptomatic BPH by a single surgeon. We retrospectively analyzed and compared the medical records of 43 patients who underwent ThuVaRP and 43 patients who underwent bipolar TURP. All patients were assessed by using the International Prostate Symptom Score, transrectal ultrasonography, the serum prostate-specific antigen (PSA) level, uroflowmetry, and postvoid residual volume before and 1 month after surgery. All complications were compared between the two groups. RESULTS: ThuVaRP was superior to TURP in catheterization time (p50 g), operation time was much longer with ThuVaRP. One month after surgery, the decrease in PSA was greater (p=0.045) with ThuVaRP than with TURP, and the increase in maximal urine flow rate was greater (p<0.001) with ThuVaRP than with TURP. The postoperative complication transient urinary incontinence was significantly different between the ThuVaRP group (nine cases, 20.9%) and the TURP group (two cases, 4.7%). Other complications were comparable between groups. CONCLUSIONS: The effectiveness and safety of ThuVaRP and TURP were comparable. ThuVaRP is a promising alternative surgical technique to TURP for BPH.

Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy

PURPOSE: Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. MATERIALS AND METHODS: From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. RESULTS: There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. CONCLUSIONS: Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.

Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy

PURPOSE: Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. MATERIALS AND METHODS: From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. RESULTS: There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. CONCLUSIONS: Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.

A Feasible Technique for Transient Vascular Occlusion by Using a Vessel Loop and Hem-o-Lok Clips in Laparoscopic Partial Nephrectomy

PURPOSE: We introduce our transient vascular occlusion technique that uses a vessel loop and Hem-o-Lok clips in laparoscopic partial nephrectomy. MATERIALS AND METHODS: From March 2009 to March 2011, 15 consecutive patients underwent laparoscopic partial nephrectomy. All operations were performed by a single surgeon using the transperitoneal approach. The transient vascular occlusion technique was as follows. After dissection of renal vessels, the vessel loop is winded twice around the vessel. Both distal portions of the vessel loop are clipped with a Hem-o-Lok clip. When vascular occlusion is required, an additional Hem-o-Lok clip is applied to the proximal portion of the vessel loop by pulling the distal portion. When no longer needed, the vessel loop is simply cut. RESULTS: All operations were performed successfully without open conversion. The mean tumor size was 2.5 cm (range, 1.1-3.5 cm). There were 8 cases of renal cell carcinoma and 7 cases of angiomyolipoma. All cases of renal cell carcinoma had a negative surgical margin. The mean operative time and the mean warm ischemic time were 176 minutes (range, 104-283 minutes) and 26.1 minutes (range, 18-34 minutes), respectively. There were no cases of uncontrollable intraoperative bleeding and no postoperative complications. CONCLUSIONS: The transient vascular occlusion technique with a vessel loop and Hem-o-Lok clips is a feasible technique with simplicity, effectiveness, and safety. It is an acceptable alternative to standard vascular occlusion techniques, such as laparoscopic bulldog or Satinsky clamps.

Ophthalmomyiasis Caused by a Phormia sp. (Diptera: Calliphoridae) Larva in an Enucleated Patient

Ophthalmomyiasis rarely occurs worldwide, and has not been reported in Korea. We present here a case of ophthalmomyiasis caused by Phormia sp. fly larva in an enucleated eye of a patient. In June 2010, a 50-year-old man was admitted to Dankook University Hospital for surgical excision of a malignant melanoma located in the right auricular area. He had a clinical history of enucleation of his right eye due to squamous cell carcinoma 5 years ago. During hospitalization, foreign body sensation developed in his right eye, and close examination revealed a fly larva inside the eye, which was evacuated. The larva was proved to be Phormia sp. based on the morphology of the posterior spiracle. Subsequently, no larva was found, and the postoperative course was uneventful without any complaints of further myiasis. This is the first case of ophthalmomyiasis among the literature in Korea, and also the first myiasis case caused by Phormia sp. in Korea.

Lymphoepithelioma-like Carcinoma of the Urinary Bladder

A 78-yr-old woman presented with gross hematuria for 2 weeks. On cystoscopy, a frond-like mass was observed at the bladder trigone. Transurethral resection of bladder tumor was performed for the mass. Histopathological findings showed that 90% of lesions were lymphoepithelioma-like carcinoma (LELCA) and a few lesions were non-invasive transitional cell carcinoma. On microscopy, syncytial growth pattern and indistinct cytoplasmic borders were observed with the severe infiltration of lymphoid cells. The case was followed-up for 8 months without recurrence. This is the first report of a LELCA case in Korea.

Early Experience with Laparoscopic Retropubic Simple Prostatectomy in Patients with Voluminous Benign Prostatic Hyperplasia (BPH)

PURPOSE: Laparoscopic simple prostatectomy was recently developed to treat voluminous benign prostatic hyperplasia (BPH). We describe the surgical technique and assess the feasibility of laparoscopic simple prostatectomy through our early experience. MATERIALS AND METHODS: The medical records of 11 patients who underwent laparoscopic simple prostatectomy between March 2008 and January 2010 were retrospectively analyzed. The subjects were limited to the patients who satisfied the following conditions: prostate volume was at least 75 g, acute urinary retention repeatedly occurred or maximal flow rate (Qmax) was at most 10 ml/s, and International Prostate Symptom Score (IPSS) was at least 12. The surgery was performed by the laparoscopic extraperitoneal approach with a transcapsular route. Feasibility was assessed by objective operative parameters (reconversion, operating time, and blood loss) and perioperative complications. Data on short-term follow-up were also available. RESULTS: The mean age of the patients was 70.6 years. Mean preoperative prostate-specific antigen and prostate volume were 6.1 ng/ml and 109.3 cc, respectively. Mean operation time was 191.9 minutes and estimated blood loss was 390.9 cc. The resected adenoma weighed on average 72.4 g. No conversion to open surgery was required. Mean preoperative IPSS and quality of life (QoL) scores were 26.86 and 4.86. Mean Qmax, measured before the surgery, was 4.5 ml/s and residual urine was 106 ml. Mean postoperative IPSS and QoL scores were 4.2 and 1.5. After the surgery, mean Qmax was 15.5 ml/s and residual urine was 24.1 ml. CONCLUSIONS: In the case of voluminous BPH, laparoscopic retropubic simple prostatectomy is expected to be a useful treatment on the condition that the learning curve can be overcome with clinical experience.

Observation of the Free-living Adults of Strongyloides stercoralis from a Human Stool in Korea / 감염과화학요법

A 76-year-old Korean man living in Cheonan, Chungcheongnam-do, visited one University Hospital with dyspnea and abdominal pain. He has been undergoing transcatheter arterial chemoembolization (TACE) for the past three years for the treatment of hepatocellular carcinoma. Abdominal pain developed 10 days ago, and became worse several days prior to coming to the emergency room. Physical examination revealed tenderness over the umbilicus. Eosinophil count was 22% without increase in the number of white blood cells. Stool examination showed adult and larval nematodes, which were subsequently identified as free-living adult worms and rhabditiform larvae of Strongyloides stercoralis. Follow-up stool examination performed six days later demonstrated only rhabditiform larvae of S. stercoralis. This is the first report on the recovery of free- living adult worms from human stool in the world.

Observation of the Free-living Adults of Strongyloides stercoralis from a Human Stool in Korea / 감염과화학요법

A 76-year-old Korean man living in Cheonan, Chungcheongnam-do, visited one University Hospital with dyspnea and abdominal pain. He has been undergoing transcatheter arterial chemoembolization (TACE) for the past three years for the treatment of hepatocellular carcinoma. Abdominal pain developed 10 days ago, and became worse several days prior to coming to the emergency room. Physical examination revealed tenderness over the umbilicus. Eosinophil count was 22% without increase in the number of white blood cells. Stool examination showed adult and larval nematodes, which were subsequently identified as free-living adult worms and rhabditiform larvae of Strongyloides stercoralis. Follow-up stool examination performed six days later demonstrated only rhabditiform larvae of S. stercoralis. This is the first report on the recovery of free- living adult worms from human stool in the world.

Risk Factors for Treatment Failure after Endoscopic Subureteral Injection of Dextranomer/Hyaluronic Acid Copolymer (Deflux(R)) for Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: Endoscopic subureteral injection of dextranomer/hyaluronic acid copolymer (Deflux(R)) has become an established alternative to long-term antibiotic prophylaxis and open ureteral reimplantation for the management of vesicoureteral reflux (VUR) in children. We retrospectively evaluated the risk factors for treatment failure after endoscopic correction of VUR. MATERIALS AND METHODS: Between 2005 and 2007, 23 boys and 26 girls (total of 69 ureters) with VUR underwent endoscopic subureteral injection of Deflux(R) primarily. VUR was unilateral in 29 patients and bilateral in 20 patients. Of the 69 ureters, VUR was grade II to V in 13, 28, 20, and 8, respectively. Follow-up urinalysis and ultrasonography were performed 1 and 3 months after the procedure, and a voiding cystourethrogram was performed at 6 or 9 months postoperatively. RESULTS: Treatment failure was defined as persistent VUR of grade II or over grade II. Endoscopic correction failed in 22 of 69 refluxing ureters. Age, sex, laterality, number of preoperative urinary tract infections, time from diagnosis to operation, presence of renal scarring, and injection volume did not influence outcome. However, preoperative presence of voiding symptoms, high-grade reflux and hydronephrosis, and having a horseshoe or golf-hole shaped ureteral orifice had a negative influence on the treatment result by univariate analysis. Severe dilatation of the lower ureter was the only statistically significant factor by multivariate analysis. CONCLUSIONS: Severity of lower ureteral dilatation is the most significant factor influencing the failure of endoscopic subureteral injection of Deflux(R). Other factors significantly involved in failure are the presence of voiding symptoms, high-grade reflux and hydronephrosis, and a horseshoe or golf-hole shaped ureteral orifice. Success rates may improve if we carefully consider these influencing factors before choosing an operative method.

A Nasal Myiasis in a 76-Year-Old Female in Korea

On July 2009, 5 fly larvae were discovered inside the nose of a 76-year-old female. She was living in Cheonan-si, and in a state of coma due to rupture of an aortic aneurysm. Surgery was performed on the day of admission, and the larvae were found 4 days later. By observing their posterior spiracle, the larvae were identified as Lucilia sericata. Considering the rapid development of this species, the infection was likely acquired during hospitalization. Further investigation on the hospital environment should be needed to know the origin of the infection.

Primary Neuroendocrine Carcinoma of the Urethra / 대한비뇨기과학회지

Primary neuroendocrine carcinomas are uncommon highly malignant tumors of the genitourinary tract, and they have a poor prognosis. We report here on a case of a primary neuroendocrine carcinoma of the urethra that developed after radical cystectomy and ileal conduit diversion for treating transitional cell carcinoma of the urinary bladder.

Transurethral Resection of Prostate for Large Benign Prostatic Hyperplasia: a Comparative Study with Open Prostatectomy / 대한남성과학회지

PURPOSE: Open prostatectomy have been considered primarily when the prostate volume is large(e.g. >75 cc). However, with the development of surgical skills and instruments, transurethral resection of prostate(TURP) can be an alternative. We assessed the feasibility of TURP for patients with large benign prostatic hyperplasia(BPH) by comparing the efficacy of TURP with that of open prostatectomy, retrospectively. MATERIALS AND METHODS: From January 2000 to March 2005, a total of 54 BPH patients with a prostate larger than 75 cc in volume on transrectal ultrasonography underwent surgery in our hospital. Among these patients, 26 patients underwent TURP(Group T) and 28 patients underwent suprapubic prostatectomy(Group O). Group T was subclassified Group T-1(prostate volume 75~100 cc, n=12) and T-2(prostate volume > or = 100 cc, n=14). In the same way, Group O was divided into Group O-1(n=9) and O-2(n=19). Operative time, time to catheter removal, hospitalization, and complications were compared. Operative results were evaluated at 6 months postoperative by comparing preoperative and postoperative International Prostate Symptom Scores(IPSS), maximal flow rates(Qmax) and post void residual(PVR). RESULTS: Preoperatively, there were no significant differences in IPSS, Qmax or PVR between Groups T-1 and O-1 or between Groups T-2 and O-2. Although delta IPSS, delta Qmax and delta PVR improved in Group O-2 more than T-2, there were no statistically significant differences between Group T-1 and O-1. The mean operative time, time to catheter removal, and hospitalization were shorter in Group T than Group O. Postoperative complication rates were similar in the T and O groups. In Group T, there was no TUR syndrome, but urinary tract infections and urethral stricture were more common than in Group O. However, Group O had higher incidences of severe complications, including wound infection or bleeding requiring transfusion. CONCLUSIONS: Open prostatectomy is commonly considered when prostate volume is greater than 75 cc. If enough resection is performed, TURP is a valuable non-invasive surgical method with respect to absence of incision, effective symptom improvement, and short hospitalization in symptomatic BPH patients who have prostate volume less than 100 cc.

Laparoscopic Radical Nephrectomy for T2 Renal Cell Carcinomas / 대한비뇨기과학회지

Purpose: A laparoscopic radical nephrectomy (LRN) has emerged as the standard care in appropriate candidates with stage T1 renal tumors (7cm or less). We extended our experience of LRN to stage T2 renal tumors (greater than 7cm), and compared the results with those of LRN for stage T1 renal tumors, as well as with those of an open radical nephrectomy (ORN) for stage T2 renal tumors. Materials and Methods: Between January 2001 and December 2004, a total of 67 patients, who underwent LRN for renal cell carcinomas, were retrospectively subdivided into the LRNT1 (n=48, tumor size7cm) groups. The surgical outcomes and perioperative morbidities were retrospectively evaluated. Also, the results of the LRNT2 group were compared with those of the open radical nephrectomy T2 group (ORNT2, n=29). Results: Compared with the LRNT1 group, the LRNT2 group only had larger tumors, but comparable operation time, blood loss, variation in the creatinine value (Cr), analgesics requirements, time to ambulate and diet, hospital stay and complication rates. The tumor sizes were similar in the two groups (p=0.260). However, the LRNT2 group had shorter operation time (p=0.039), lesser blood loss (p=0.044), Cr (p=0.027), analgesic requirements (p<0.001) and time to ambulation, diet and hospital stay (p<0.001, all). Conclusions: A LRN for stage T2 renal tumors is feasible and efficacious. The surgical outcomes were comparable with those of a LRN for stage T1 tumors, with the advantages of decreased blood loss and more rapid recovery over that of an ORN for comparable tumors greater than 7cm in size.

Amyloidosis of the Prostate / 대한남성과학회지

Amyloidosis of the prostate is a rare disease. With more patients undergoing biopsy of the prostate to exclude malignancy, the likelihood of identifying primary or secondary amyloidosis of the prostate has increased. We report a case of amyloidosis of the prostate in a 70-year-old man. The diagnosis was made from prostatic biopsy. Later, he was diagnosed with prostatic adenocarcinoma after transurethral resection of the prostate due to persistent lower urinary tract symptoms.

Amyloidosis of the Prostate / 대한남성과학회지

Amyloidosis of the prostate is a rare disease. With more patients undergoing biopsy of the prostate to exclude malignancy, the likelihood of identifying primary or secondary amyloidosis of the prostate has increased. We report a case of amyloidosis of the prostate in a 70-year-old man. The diagnosis was made from prostatic biopsy. Later, he was diagnosed with prostatic adenocarcinoma after transurethral resection of the prostate due to persistent lower urinary tract symptoms.

Risk Factors for Subsequent Bladder Cancer Recurrence following Radical Surgery for Upper Urinary Tract Urothelial Cancer / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to determine the clinical and pathological risk factors for subsequent bladder recurrence for the patients suffering with transitional cell carcinoma in the upper urinary tract (UUT-TCC) following radical surgery, and these factors should allow more accurate prediction of the disease outcome. MATERIALS AND METHODS: Between 1995 and 2004, a total of 71 patients underwent total nephroureterectomy for UUT-TCC. Patients with concomitant or previous bladder tumor or a follow-up period of less than 1 year were excluded in this study. Univarariate and multivariate analysis by Cox's proportional hazards model was used to determine the independent risk factors for intravesical tumor recurrence. RESULTS: Fifteen out of 71 patients (21.1%) experienced subsequent intravesical tumor recurrence during a mean follow-up period of 16.5 months (range: 3-28). On univariate analysis, tumor size, multiplicity, stage and grade were significantly correlated with subsequent intravesical tumor recurrence. On the multivariate analysis, tumor stage and multiplicity had a statistically significant impact on the risk of subsequent intravesical tumor recurrence. CONCLUSIONS: Tumor stage and multiplicity are important factors for subsequent intravesical tumor recurrence in the patients who suffer with UUT-TCC following surgery. Therefore, closer follow-up might necessary for patients with multiple foci and high stage UUT-TCC for the early detection of subsequent intravesical tumor recurrences.