Intravesical sealing of the distal ureter in nephroureterectomy.
OBJECTIVE
To study the effectiveness and reliability of a new minimally invasive technique for the treatment of the terminal ureter in nephroureterectomy due to transitional cell carcinoma, both in open and laparoscopic procedures.


METHODS
Observational retrospective study of 14 patients that underwent intravesical sealing and endoscopic excision of terminal ureter, before ureterectomy (11 laparoscopic, 3 open), due to an upper urinary tract tumor, between July 2003 and November 2007. This procedure was performed on 11 males and 3 females, average age 59.5 years, )range: 35-70). The tumor settled on the renal pelvis in 12 cases and on the proximal ureter in 2. Stage was Ta - T1 in 10 patients, T2 in 3, and T3 in 1. Tumor grade was G3 in 9 cases and G2 in 5. Excision was carried out with a Collins knife. In order to avoid contact between the urine and retroperitoneal space, the meatus was quickly sealed with a clip introduced by means of a transvesical trocar.


RESULTS
Total surgical time of nephroureterectomy was 231.15 minutes (range 200-340). Global complication rate for the procedure was 28.4%, but the rate for the cases associated with this technique (meatus sealing and disinsertion) was 14.2%. All patients were discharged after removing bladder catheter. Mean hospital stay was 10.14 days (range: 6-22). After an average follow-up of 25.3 months (range: 12-64), no retroperitoneal recurrence has been reported. One of the patients had bladder recurrence and another one developed metastasis to the suprarenal gland that was treated satisfactorily.


CONCLUSIONS
Quick sealing of distal ureter by transvesical application of a clip before its endoscopic excision in nephrourecterectomy is a sound technique from an oncological point of view, with an acceptable complication rate that avoids a second open time to manage distal ureter.
Sesmero
Jose H Amón
JH
Urology Department. University Hospital Rio Hortega. Valladolid. Spain. amonsesmero@yahoo.es
Redondo
Consuleo Conde
CC
Delgado
Marcos Cepeda
MC
Royo
Fátima Castroviejo
FC
Tesedo
Venónica Rodríguez
VR
Oceja
José M Martínez-Sagarra
JM
D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D018666:Ureteroscopy