Stripping technique for endoscopic management of distal ureter during nephroureterectomy: experience of 32 procedures.
OBJECTIVE
To assess the results of the stripping technique for endoscopic management of the distal ureter during nephroureterectomy.


METHODS
Since 1995, 32 patients have undergone open nephroureterectomy involving stripping of the distal ureter for upper urinary tract carcinoma. After endoscopic placement of a Chevassu ureteral catheter, nephrectomy was performed using a lumbotomy approach. The catheter tip was tied to the top of the ureteral extremity. At the end of the intervention, the catheter was pulled out transurethrally to intussuscept the distal ureter. Endoscopic resection through the bladder muscular wall was performed around the everted ureteral orifice, then the distal ureter was stripped and removed with a bladder cuff.


RESULTS
The mean operative time was 180 minutes, and the mean blood loss was 220 mL. The stripping failed in 6 patients (18.7%), requiring an iliac incision. The reasons for failure were a retained ureter in 5 cases and ureteral breakage in 1 case. The mean duration of urethral catheterization was 5 days, and the mean hospital stay was 8 days. The complication rate was 3.1%. At a median follow-up of 35.2 months, 9 patients (28.1%) had experienced recurrence: 6 with superficial bladder tumors, 2 with renal fossa recurrence, and 1 with asynchronous liver metastases. The disease-specific mortality rate was 9.4%.


CONCLUSIONS
These results confirm that the stripping technique for endoscopic management of the distal ureter during open nephroureterectomy is a simple and safe procedure.
Giovansili
Bertrand
B
Department of Urology, Cochin Hospital, Paris, France.
Peyromaure
Michaël
M
Saïghi
Djillali
D
Dayma
Thierry
T
Zerbib
Marc
M
Debré
Bernard
B
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009366:Neoplasm Seeding; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*; D014546:Urinary Catheterization / Q000295:instrumentation