Simultaneous radical nephroureterectomy and transurethral distal ureter balloon occlusion and detachment

World Journal of Surgical Oncology

Technical Innovations

Francesca Sanguedolce¹  Vito Mancini²  Oscar Selvaggio²  Giuseppe Carrieri²  Luigi Cormio²  Giuliano Ciavotta²  Paolo Massenio²  Giuseppe Di Fino² 

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

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

DOI  :  10.1186/1477-7819-12-345

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

来源: Springer

【 摘 要 】

BackgroundDistal 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.MethodsBetween 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.ResultsMean 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.ConclusionsSimultaneous 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】

CC BY   
© Cormio et al.; licensee BioMed Central Ltd. 2014