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European UrologyVolume 61, issue 4, pages e23-e40, April 2012
Reply from Authors re: Brant A. Inman. Open Versus Laparoscopic Nephroureterectomy: Is There Really a Debate? Eur Urol 2012;61:722–3
Published online 1 February 2012, page 724
Refers to article:
Open Versus Laparoscopic Nephroureterectomy: Is There Really a Debate?
April 2012 (Vol. 61, Issue 4, pages 722 - 723)
Refers to article:
Propensity-Score-Matched Comparison of Perioperative Outcomes Between Open and Laparoscopic Nephroureterectomy: A National Series
Accepted 13 December 2011
April 2012 (Vol. 61, Issue 4, pages 715 - 721)
We read with interest the editorial comment made by Inman  on our recent paper that compared short-term in-hospital outcomes between open nephroureterectomy (ONU) versus laparoscopic nephroureterectomy (LNU) . The propositions made within the comment summarize the inherent considerations that should be accounted for, not only of our report, but also of the bulk of existing literature addressing the same topic , , , , and . Given the low incidence and rarity of upper tract urothelial carcinomas (UTUCs) , it is not surprising that no randomized trial has been designed to compare morbidity or mortality between ONU and LNU. In the future, despite the necessity, such a trial will remain unlikely to happen. What is left are institutional and population-based data, both study cohorts holding advantages and disadvantages of their own. Ultimately, the goal of all such reports is to reach a consensus for both the patient and the clinician. To date, no study, including our recent report , can reliably and validly cover all the unknowns of the topic. Nonetheless, the totality of all such reports, whether institutional or population based, prospectively or retrospectively designed, sheds light on what has been addressed as well as what remain to be addressed.
Our group, along with other investigators, have confirmed the potential role of LNU for the treatment of patients diagnosed with UTUC, both within centers of excellence and within the community , , , , and . Future studies will likely address the details that were lacking in such reports and possibly answer some questions that remain to be resolved. We agree with Inman that a formal comparison with a randomization factor will likely diminish the selection biases often present in retrospective cohorts. Nonetheless, such a trial may never occur. Even if it would, one cannot dismiss findings from existing studies that sought to address the paucity of data based on their observational or retrospective nature.
Conflicts of interest
The authors have nothing to disclose.
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a Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
b Department of Urology, University of Montreal Health Center, Montreal, Canada
c Department of Urology, Vita Salute San Raffaele University, Milan, Italy
Corresponding author. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Hospital St-Luc, 1058, rue St-Denis, Montreal, Quebec, Canada, H2X 3J4. Tel. +1 514 890 8000 ext. 35335; Fax: +1 514 227 5103.
© 2012 European Association of Urology, Published by Elsevier B.V.
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