Intravesical recurrence after therapeutic ureteroscopy for upper tract urothelial carcinoma: a meta-analysis

To assess the role of ureteroscopy (URS) with laser ablation on oncological outcomes, namely, intravesical recurrence (IVR) rate, radical nephroureterectomy (RNU)-to-treat ratio and overall survival (OS), in patients with upper tract urothelial carcinoma (UTUC), an area of study that has been insufficiently addressed in the literature.

A systematic search (PROSPERO: CRD42025642480) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A pooled analysis was performed to quantify the effect size (ES) for IVR rate, radical nephroureterectomy (RNU)-to-treat ratio and OS. Subgroup analyses were performed to evaluate patients who received postoperative instillations and to compare URS with laser ablation to RNU.

Overall, 24 studies involving 1904 patients were included in the final analysis. The overall rate of IVR was 23.7% (n = 453). The overall pooled analysis showed an ES for IVR of 0.33, for RNU-to-treat ratio of 0.23, and for OS of 0.62 (all P ≤ 0.005). In the comparison between URS and RNU, the pooled ES of URS for IVR was 1.14 and for OS it was 1.43 (all P > 0.05). Within the subgroup analysis of patients who received postoperative instillations, the pooled ES for IVR was 0.38 (P = 0.029) and for RNU-to-treat ratio it was 0.25 (P = 0.012).

In this systematic review, URS with laser ablation was found to exert a negligible effect on IVR rate. Moreover, no statistically significant differences in IVR nor in OS were recorded when URS was compared to RNU. URS can be performed without compromising the oncological outcomes of patients with UTUC.