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Purpose: To analyze lymph node invasion (LNI) rates according to tumor characteristics and to test the impact of LNI and its extent on cancer specific mortality (CSM) in surgically-treated non metastatic urothelial upper urinary tract carcinoma (UTUC) patients. Materials and methods: Within the SEER database (2004–2014), we identified 2098 patients with histologically confirmed non-metastatic urothelial carcinoma of renal pelvis or ureter who underwent NU with LND. LNI rates stratified according to tumor location and stage were described. Kaplan-Meier plots illustrated CSM rates according to LNI and its extent. Multivariable Cox regression models (MCRMs) tested the effect of LNI and its extent on CSM. Results: Of 2098 UTUC patients, who underwent nephroureterectomy with lymph node dissection, 646 (33%) had LNI. The median number of removed lymph nodes was 3 [Interquartile range (IQR): 1–7]. The median number of positive lymph nodes in patients, who harbored LNI was 1 (IQR:1–3). LNI rates according to tumor location were, respectively, 23.6% for ureteral and 36.5% for renal pelvis tumors. LNI rates according to tumor stage were 9.6, 18.0, 38.7 and 63.9%, for respectively, T1, T2, T3 and T4 UTUC. In MCRMs, LNI achieved independent predictor status for higher CSM (HR 3.00; p < 0.001). Finally, in MCRMs, number of positive lymph nodes defined as the 75th percentile (n ≥ 3) achieved independent predictor status for higher CSM (HR 1.37; p = 0.04). Conclusions: LNI in non-metastatic UTUC patients is the most important determinant of CSM. Number of positive lymph node is independently associated with higher CSM. In consequence, lymph node dissection can provide extensive prognostic information.

Author of the Study: The COVID-19 outbreak has brought challenges to the global healthcare community. The management of upper urinary tract stones has been affected even further, with potential severe sequelae for patient’s health. Materials and Methods: We report a multicentric retrospective study involving 9 Centers regularly delivering treatment for upper tract urinary stones across the country. All Centers suffered significant limitations during the pandemic period due to government limitations. We compared the 12 months-period prior to COVID-19 (from march 1st 2019 to February 28th 2020, named as period A) with postCOVID-19 period (from march 1st, 2020 to February 28th, 2021 named as period B). Aim of the study was to compare endourological procedures for upper urinary stones during period A and the period B. This study investigated all types of surgeries delivered in both elective and emergency setting. Results: A total of 4018 procedures were collected, including 2176 procedures in period A. In period B, 1842 procedures were carried out, corresponding to a loss of 15.35% of cases (p < 0.001). Looking into elective cases, 1622 procedures were delivered in period A, compared to 1280 in period B, resulting in a loss of 342 cases corresponding to 21.81% (p = 0.001). All types of stone treatments resulted affected, including ESWL (from 487 cases in period A to 344 in period B, − 29.37%, p = 0.001), PCNLs (from 170 to 125 cases, corresponding to − 26.47%, p:0.008), retrograde surgery for renal stones (from 433 to 387 cases, − 10.63%, p = 0.008) and for ureteric stones (from 614 cases to 484, − 21.18%, p.008). Additionally, waiting lists resulted affected, with significant delays in period B. In particular, for ureteric stones, mean waiting time in period A was 61.5 days compared to 87.5 days in period B (p = 0.008). Regarding renal stones, waiting list increased from 64.74 days in period A to 85.66 days in period B for RIRS. The waiting list for percutaneous surgeries increased from 79 days to 103 days (p = 0.001). We did not find any patient which acquired COVID-19 during hospitalization for elective or urgent surgery. We also found a longer waiting list for pre-stented patients, resulting to be 86.5 days in period B compared to 64 days in period A (p < 0.005). Conclusions: Our study showed how COVID-19 caused a significant disruption in endourological services across the country. Our data underlined how less patients received treatment in a longer time. This can potentially lead to an increased risk of stone- related complications, including sepsis and kidney loss.