Introduction When performing open or laparoscopic nephroureterectomy (LNU), the optimal way to excise the distal ureter remains controversial. There are concerns that primary endoscopic detachment of the intramural ureter is associated with adverse outcomes. Existing studies have limited patient numbers and inadequate oncologic follow up. We provide our institutions experience of this technique. Methods Data was collected prospectively on 59 patients (37 men) who underwent LNU over a 10 year period at a single centre using a standardized technique; initial endoscopic circumferential release of the distal ureter and bladder cuff followed by retroperitoneal en bloc LNU. Results Patients had a mean age of 67 years and Charlson score of 2. One case was converted to open surgery. Mean operative time was 194 minutes with estimated blood loss 125 ml. Three patients (5%) required a blood transfusion. Mean in-patient stay was 3 days. 46 patients had urothelial carcinoma. 71% of patients had high grade disease (n=33) and 21% had distal ureteric disease (n=10). One patient required open excision of recurrence at the site of the excised ureteric orifice and remains disease free 5 years later. 5 year cancer specific survival was 100% for patients with stage pTa (n=7) and pT1 (n=14), 93% for pT2 (n=7) disease and 49% for patients with pT3 (n=18) disease. Conclusions Transurethral resection of the ureteric orifice during laparoscopic nephro-ureterectomy achieves acceptable long-term oncologic outcomes whilst minimising peri-operative morbidity and in-patient stay. This represents the largest single centre study of this technique to date.
Journal of endourology. 2017 Apr 06 [Epub ahead of print]
Aakash Pai, Muddassar Hussain, Richard G Hindley, Amr Emara, Neil Barber
Frimley Health NHS Foundation Trust, 2133, Urology , portsmouth road , Frimley, United Kingdom of Great Britain and Northern Ireland , GU16 7UJ ; ., Frimley Health NHS Foundation Trust, 2133, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland ; ., Frimley Health NHS Foundation Trust, 2133, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland., Frimley Health NHS Foundation Trust, 2133, Frimley, Surrey, United Kingdom of Great Britain and Northern Ireland ; .