V5-14: Intramural tunnel ureterectomy for treatment of upper tract urothelial tumor.
VideoIntroductions and Objectives
Nephroureterectomy with bladder cuff excision is the gold standard for the treatment of upper tract transitional cell carcinoma. Distal ureterectomy with bladder cuff removal is a technically challenging procedure and is associated with various complications. The goal of bladder cuff excision is completion of oncologic control of the affected renal unit. In this video we propose performing distal ureter excision with dissection and detachment of the intramural ureter without bladder cuff excision.
After visualizing the ureter entrance into the bladder, we dissected the intramural ureter up to the bladder mucosa while identifying the Valdeyer sheath. The distal 1 cm of the ureter was sealed using the Ligasure instrument and the ureter was detached with the entire specimen without violating the urinary tract and avoiding bladder wall excision.
Thus far 12 patients aged 59- 87yrs ( 9 men ) underwent distal ureterectomy using this technique. Mean operating time of nephroureterectomy was 230 minutes and blood loss -110 cc. During follow-up of 1 to 72 months two patients suffered from bladder recurrence, one in the ipsilateral orifice and another in other part of bladder. TUR-BT was enough for bladder clearancein both cases. There were no patients with local extraurinary recurrence.
We suggest that this modified technique may reduce complications associated with distal ureterectomy while maintaining adherence to oncologic principles.