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Combining Hand Assisted Laparoscopic Nephroureterectomy With Cystoscopic Circumferential Excision of the Distal Ureter Without Primary Closure of the Bladder Cuff—Is it Safe?

2005; Lippincott Williams & Wilkins; Volume: 175; Issue: 1 Linguagem: Inglês

10.1016/s0022-5347(05)00046-7

1527-3792

Eliecer Kurzer, Raymond J. Leveillee, Vincent G. Bird,

Ureteral procedures and complications

No AccessJournal of UrologyAdult urology1 Jan 2006Combining Hand Assisted Laparoscopic Nephroureterectomy With Cystoscopic Circumferential Excision of the Distal Ureter Without Primary Closure of the Bladder Cuff—Is it Safe? Eliecer Kurzer, Raymond J. Leveillee, and Vincent G. Bird Eliecer KurzerEliecer Kurzer , Raymond J. LeveilleeRaymond J. Leveillee , and Vincent G. BirdVincent G. Bird View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00046-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We have previously described our technique of combining HAL-NU using early ureteral ligation with simultaneous cystoscopic circumferential excision of the distal intramural ureter without primary closure of the bladder cuff. We report the oncological sequelae in patients who underwent HAL-NU using our technique of complete ureteral removal. Materials and Methods: We retrospectively evaluated all patients who underwent HAL-NU from April 1999 through July 2004. Cystograms were performed 1 week postoperatively in all patients. Pathological findings were reviewed. Cystoscopy was performed every 3 months to assess bladder recurrences. Upper tract imaging was performed postoperatively and then annually. The locations of recurrence and need for adjuvant treatment were assessed. Results: A total of 49 patients with an average age of 67 years underwent HAL-NU. Gravity cystography confirmed that bladder defects had completely sealed at 1 week in all patients. Mean followup was 10.6 months (median 10, range 1 to 52). Of the patients 20 (49%) had bladder tumors postoperatively. Two patients were found to have advanced stage disease, leading to chemotherapy with radiation therapy in 1 and radical cystectomy in the other at 4 and 14 months, respectively. A total of 25 patients had postoperative pelvic imaging. Four patients with pathological stage T2 (1) and T3 (3) had metastatic disease at followup. One patient was known to have pulmonary metastases preoperatively and HAL-NU was performed for refractory hematuria. Two patients were noted to have distant metastases to the liver, lung and bone at 1 and 3 months postoperatively, respectively. One patient was found to have distant metastases to the liver and retroperitoneal lymph nodes 2 years after surgery. No patients were found to have local pelvic or peritoneal metastases. Conclusions: HAL-NU with cystoscopic excision of the distal ureter is feasible, safe and effective for upper tract transitional cell carcinoma. Oncological sequelae are comparable to results after open surgery. There is no evidence to suggest pelvic or peritoneal tumor seeding since no cases of pelvic or abdominal recurrence were discovered after surgery, while allowing the bladder defect to close spontaneously with catheter drainage. 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Abstract, Google Scholar Division of Endourology and Laparoscopy, Department of Urology, University of Miami School of Medicine, Miami, Florida© 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byAboumohamed A, Krane L and Hemal A (2018) Oncologic Outcomes Following Robot-Assisted Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial CarcinomaJournal of Urology, VOL. 194, NO. 6, (1561-1566), Online publication date: 1-Dec-2015.Walton T, Sherwood B, Parkinson R, Obakponovwe O, Thomas S, Taylor M, England R and Lemberger R (2018) Comparative Outcomes Following Endoscopic Ureteral Detachment and Formal Bladder Cuff Excision in Open Nephroureterectomy for Upper Urinary Tract Transitional Cell CarcinomaJournal of Urology, VOL. 181, NO. 2, (532-539), Online publication date: 1-Feb-2009. Volume 175Issue 1January 2006Page: 63-67 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsnephrectomycarcinomalaparoscopytransitional cellkidneyureterMetricsAuthor Information Eliecer Kurzer More articles by this author Raymond J. Leveillee Financial interest and/or other relationship with Ethicon, Applied Medical, Merck, Boston Scientific and ACMI. More articles by this author Vincent G. Bird More articles by this author Expand All Advertisement PDF downloadLoading ...