title: Retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for native upper tract transitional cell carcinoma ipsilateral to a transplanted kidney.
abstract: OBJECTIVE
  We present preliminary experience of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with bladder cuff excision by combining cystoscopic resection with open transperitoneal dissection for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney.
  
  
  METHODS
  Thirteen renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU between November 2005 and August 2008. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment, and the intact specimen was removed manually via the same incision. The cystostomy was generally not sutured.
  
  
  RESULTS
  The mean operation time was 264 minutes. The mean estimated blood loss was 256 mL. Three patients needed blood transfusion. No open conversion was required. Two patients experienced minor complications. Pathologic findings confirmed UUT-TCC in all patients with 8 of the pelvis and 7 of the ureter. Four were involved with bladder TCC. With the mean follow-up of 30 months, none of the patients developed retroperitoneal recurrence or distant metastasis, 2 of the 4 patients with bladder TCC had recurrence in the bladder, and 2 had contralateral UUT-TCC after the first unilateral nephroureterectomy.
  
  
  CONCLUSIONS
  RPLNU with bladder cuff excision by combining cystoscopic resection with open transperitoneal dissection might be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with acceptable oncological outcomes.
authors.affiliation: Department of Urology, Peking University Third Hospital, Beijing, China.
authors.forename: Jianfei
authors.initials: J
authors.lastname: Ye
authors.forename: Lulin
authors.initials: L
authors.lastname: Ma
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Hou
authors.forename: Chunlei
authors.initials: C
authors.lastname: Xiao
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.forename: Guoliang
authors.initials: G
authors.lastname: Wang
authors.forename: Kai
authors.initials: K
authors.lastname: Hong
authors.forename: Jian
authors.initials: J
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D003559:Cystostomy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery