Objectives: To investigate whether ureteroscopy ( URS ) before radical nephroureterectomy ( RNU ) for upper tract urothelial carcinomas ( UTUC s) has an impact on oncological outcomes. Patients and Methods: We performed a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described URS performed on patients with UTUC and conducted a standard meta‐analysis on survival outcomes. Results: Our meta‐analysis included eight eligible studies containing 3975 patients. The results were as follows: cancer‐specific survival ( CSS ; hazard ratio [ HR ] 0.76, 95% confidence interval [ CI ] 0.59–0.99; P = 0.04), overall survival ( OS ; HR 0.76, 95% CI 0.48–1.21; P = 0.24), recurrence‐free survival ( RFS ; HR 0.89, 95% CI 0.69–1.14; P = 0.37), metastasis‐free survival ( MFS ; HR 1.06, 95% CI 0.82–1.36; P = 0.66), and intravesical recurrence‐free survival ( IRFS ; HR 1.51, 95% CI 1.29–1.77; P < 0.001). When excluding previous bladder tumour history, the result for IRFS was a HR of 1.81 (95% CI 1.53–2.13; P < 0.001). Conclusions: This meta‐analysis indicated that URS before RNU did not have a negative impact on CSS , OS , RFS , or MFS in patients with UTUC . However, patients were at higher risk of intravesical recurrence after RNU when they had undergone URS before RNU . Further studies are needed to assess the effects of post‐ URS intravesical chemotherapy on intravesical recurrence.

Lymph node dissection (LND) is not routinely performed during radical nephroureterectomy (RNU) in upper tract urothelial carcinomas (UTUC) and the role of LND has been controversial. We aim to investigate whether patients with LND had improved survival in UTUC patients. We performed a systematic literature search of PubMed, Embase, and Cochrane library for citations published prior to January 2016, describing LND performed among UTUC patients and conducted a standard meta-analysis of survival outcomes. Eleven eligible studies containing 7516 patients satisfied the inclusion criteria. Pooled HRs for cancer-specific survival (CSS) and recurrence-free survival (RFS) were 1.17 (P = 0.18) and 1.33 (P = 0.19) respectively. However, the patients in the LND group had more advanced tumour stages and grades (P < 0.001). Further subgroup analysis showed that among muscle-invasive UTUC patients, the pooled HR for CSS and RFS were 1.10 (P = 0.42) and 0.92 (P = 0.72) respectively. Besides, no difference was found in CSS and RFS between pN0 and pNx individuals in overall populations and in patients with muscle-invasive UTUC, while pN+ patients had significantly worse prognosis when compared to pN0 patients. LND during RNU allows more accurate staging and prediction of survival, but it remains uncertain whether LND independently improves survival in patients with UTUC. However, standard use of LND should be further investigated in a multi-center, prospective evaluation to obtain a definitive statement regarding this matter.