Clinical practice patterns for upper tract urothelial carcinoma: a nationwide survey in Japan

Objective: A comprehensive survey has not yet been conducted to investigate care patterns by urologists for the management of upper tract urothelial carcinoma. Methods: We conducted a nationwide survey for urologists treating upper tract urothelial carcinoma patients. The questionnaire was approved by the Japanese Urological Association and sent by mail in February 2014 to 1119 institutes in Japan. We identified 627 responders for this study. Results: Our survey demonstrated that ( i) the mean number of radical nephroureterectomy cases per institution in 2013 was 7.6, ( ii) the main detecting tool for upper tract urothelial carcinoma is contrast-enhanced computed tomography, ( iii) the need for ureteroscopic evaluations is highly dependent on voiding urine cytology results, ( iv) 67% of urologists always or often perform radical nephroureterectomy by laparoscopic surgery, ( v) more than half of the urologists do not aggressively perform lymph node dissection, ( vi) 75% of the urologists perform bladder cuff incision through an extravesical approach, ( vii) urologists perform kidney-sparing surgery following various indications, ( viii) 59% of the urologists always perform adjuvant systemic chemotherapy for high-risk upper tract urothelial carcinoma patients, ( ix) the combination of gemcitabine and cisplatin is the most frequent chemo-regimen for metastatic upper tract urothelial carcinoma, and gemcitabine and cisplatin with dose reductions is also the first choice even in patients with impaired renal function and ( x) 10.5% of urologists always or sometimes perform single intravesical chemotherapy immediately after radical nephroureterectomy. Conclusions: The management strategy for upper tract urothelial carcinoma has changed with the introduction of new devices and development of instruments. The lack of clear evidence for relatively uncommon upper tract urothelial carcinoma affects the consistency of its treatment strategies.