Abstract：Objective:Laparoscopic retroperitoneal nephroureterectomy (LNU) is a well-established technique for managing upper urinary tract urothelial cancer. However, management of the distal ureter remains a controversial issue. We describe a new method of cystoscopic sleeve resection of the distal ureter using a 2 μm continuous wave laser before LNU.Methods:We performed LNU in 38 patients between Jan 2008 and Dec 2012. The lower end of the ureter was managed using our new technique. We evaporated and excised the ureteric orifice with a bladder cuff using a 2 μm continuous wave laser. LNU was performed using a standard technique, while leaving the ureter intact. The ureter was dissected to the entrance of bladder. Then, the distal ureter was easily detached from the bladder.Results:We achieved complete excision of the distal ureter with a bladder cuff in all cases using our new technique. The average operative time and bleeding volume was 126 minutes and 60.2 ml, respectively. The cause-specific patient survival rate at 2 year was 100%. The bladder recurrence-free rate at 2 year was 87.1%. The extravesical recurrence-free rate at 2 year was 100%.Conclusions:Our new technique appears to be a simple, less invasive, and oncologically-safe method to manage the distal ureter.
[1]Rouprêt M,Zigeuner R,Palou J,et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol, 2011,59(4):584-594. [2]Hattori R, Yoshino Y, Gotoh M,et al. Laparoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter: Nagoya experience.Urology,2006,67(4):701-705. [3]Viprakasit DP, Macejko AM,Nadler RB. Laparoscopic nephroureterectomy and management of the distal ureter: a review of current techniques and outcomes.Adv Urol, 2009,721371. [4]Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy. N Engl J Med, 1991, 324(19):1370-1371. [5]Kamihira O, Hattori R, Yamaguchi A, et al. Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol, 2009,55(6):1397-1407. [6]Gerber GS, Stockton BR. Update on laparoscopic nephrectomy and nephroureterectomy. J Endourol, 2005,19(10):1151-153. [7]Yang Y, Wei ZT, Zhang X, et al.Transurethral partial cystectomy with continuous wave laser for bladder carcinoma. J Urol, 2009,182(1):66-69. [8]Rouprêt M, Hupertan V, Sanderson KM, et al. Oncologic control after open or laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: a single center experience. Urology, 2007,69(4):656-661. [9]Desai MM, Strzempkowski B, Matin SF,et al. Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy. J Urol, 2005,173(1):38-41. [10]Berger A, Fergany A. Laparoscopic nephroureterectomy: oncologic outcomes and management of distal ureter; review of the literature. Adv Urol, 2009,826725. [11]Macejko AM, Pazona JF, Loeb S, et al. Management of distal ureter in laparoscopic nephroureterectomy——a comprehensive review of techniques. Urology, 2008,72(5):974-981. [12]Guzzo TJ, Schaeffer EM, Allaf ME. Laparoscopic radical nephroureterectomy with en-bloc distal ureteral and bladder cuff excision using a single position pneumovesicum method.Urology, 2008,72(4):850-852. [13]Ghazi A, Shefler A, Gruell M, et al. A novel approach for a complete laparoscopic nephroureterectomy with bladder cuff excision. J Endourol, 2010,24(3):415-419. [14]Tan BJ, Ost MC, Lee BR. Laparoscopic nephroureterectomy with bladder-cuff resection: techniques and outcomes. J Endourol, 2005,19(6):664-676. [15]Gill IS, Soble JJ, Miller SD, et al. A novel technique for management of the en bloc bladder cuff and distal ureter during laparoscopic nephroureterectomy. J Urol, 1999,161(2):430-434. [16]Agarwal DK, Khaira HS, Clarke D, Tong R. Modified transurethral technique for the management of distal ureter during laparoscopic assisted nephroureterectomy. Urology, 2008,71(4):740-743. [17]Mueller TJ, DaJusta DG, Cha DY, et al. Ureteral fibrin sealant injection of the distal ureter during laparoscopic nephroureterectomy-a novel and simple modification of the pluck technique. Urology, 2010,75(1):187-192. [18]Shalhav AL, Dunn MD, Portis AJ, et al. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J Urol, 2000,163(4):1100-1104. [19]Lambert EH, Schachter LR, Altamar HO, et al. A sealed bladder cuff technique during laparoscopic nephroureterectomy utilizing the LigaSure electrosurgical device: laboratory and clinical experience. J Endourol, 2010,24(3):327-332. [20]Muntener M, Nielsen ME, Romero FR,et al. Long-term oncologic outcome after laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma. Eur Urol, 2007,51(6):1639-1644. [21]Schatteman P, Chatzopoulos C, Assenmacher C, et al. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: results of a Belgian retrospective multicentre survey. Eur Urol, 2007,51(6):1633-1638. [22]Manabe D, Saika T, Ebara S, et al. Comparative study of oncologic outcome of laparoscopic nephroureterectomy and standard nephroureterectomy for upper urinary tract transitional cell carcinoma. Urology, 2007,69(3):457-461.
