Simultaneous radical nephroureterectomy and transurethral distal ureter balloon occlusion and detachment

World Journal of Surgical Oncology

Giuseppe Carrieri¹  Vito Mancini¹  Giuliano Ciavotta¹  Francesca Sanguedolce²  Paolo Massenio¹  Giuseppe Di Fino¹  Oscar Selvaggio¹  Luigi Cormio¹ 

[1] Department of Urology and Renal Transplantation, University of Foggia, Viale L Pinto 1, 71121 Foggia, Italy;Department of Pathology, University of Foggia, Foggia, Italy

关键词: Nephroureterectomy;    Upper urinary tract;    Urothelial carcinoma;   

Others  :  1147395
DOI  :  10.1186/1477-7819-12-345

 received in 2014-08-21, accepted in 2014-10-29,  发布年份 2014

【 摘 要 】

Background

Distal ureter bladder cuff (DUBC) excision is an essential part of radical nephroureterectomy (RNU) but there is no agreement on the ideal surgical technique to achieve it. We describe a novel technique for endoscopic DUBC excision during RNU that complies with the oncological principle of preventing spillage of tumor cells, by occluding the distal ureter before its excision, while shortening surgical time, and by avoiding repositioning the patient.

Methods

Between June 2010 and May 2012, 10 patients underwent simultaneous open RNU and transurethral distal ureter balloon occlusion and detachment using a flexible cystoscope (f-TUDUBOD) in lumbotomy position. After having ruled out the presence of a concomitant bladder tumor, one surgeon used a flexible cystoscope to occlude the affected ureter with a 5Fr Fogarty catheter and circumferentially incised the orifice until detaching it from the bladder with a boogie electrode or a Holmium laser; meanwhile, two other surgeons performed open RNU through a lumbotomic approach. Data were compared with those of patients who had previously undergone open RNU after TUDUBOD.

Results

Mean surgical time for simultaneous open RNU and f-TUDUBOD was 113.4 ± 29.2 minutes, significantly shorter (P <0.01) than that for open RNU after TUDUBOD (154.2 ± 26.4 minutes). There were no complications. Surgical margins were always negative; at mean follow-up of 31.1 months, there was no recurrence in the perivesical space and a 20% (2/10) bladder recurrence rate comparing favorably with that (23.1%) observed at 30-month follow-up in patients who had undergone open RNU after TUDUBOD.

Conclusions

Simultaneous open RNU and f-TUDUBOD proved to be feasible and to represent a safe and effective means of shortening surgical time, with obvious clinical and economical benefits.

【 授权许可】

   
2014 Cormio et al.; licensee BioMed Central Ltd.

【 图 表 】

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