title: Comparison of distal ureteral management strategies during laparoscopic nephroureterectomy.
abstract: OBJECTIVE
  The optimal approach for management of the distal ureter and bladder cuff (DUBC) during laparoscopic nephroureterectomy (LNU) for upper-tract transitional-cell carcinoma (TCC) is controversial. We describe our contemporary experience with LNU and compare several approaches to the DUBC.
  
  
  METHODS
  A retrospective analysis was performed on 36 patients undergoing LNU. Three approaches to the DUBC were used: Open resection (OR), complete laparoscopic dissection and suture reconstruction (LR), and laparoscopic dissection with DUBC stapling (LS). Patient demographics and intraoperative, perioperative, and pathologic variables were compared. Estimated 2-year recurrence-free survival (RFS) was calculated.
  
  
  RESULTS
  A total of 36 patients were analyzed: 10 OR, 12 LR, and 14 LS. The mean age was 69.6 years with a mean follow-up of 15 months. The LR and LS groups had significantly shorter operative times compared with the OR group (163 and 152 vs 276 minutes, respectively (P<0.05). The LR group had the shortest mean length of stay compared with the OR and LS groups (2.0 vs 3.5 and 2.7 days, respectively, P<0.05). No patient had a complete ureteral orifice, but a cystoscopically appreciable remnant of the resected ureteral orifice was noted in 50% of the LS group vs none with the LR and OR groups (P<0.05). The estimated 2-year RFS was 65% for the entire cohort with no significant differences among groups.
  
  
  CONCLUSIONS
  Complete laparoscopic resection of the DUBC is feasible, particularly in low-stage, low-grade upper tract TCC and provides benefits such as shorter operative times and length of stay compared with an open bladder cuff excision.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York 10032, USA.
authors.forename: Chad R
authors.initials: CR
authors.lastname: Ritch
authors.forename: Jamie T
authors.initials: JT
authors.lastname: Kearns
authors.forename: Adam C
authors.initials: AC
authors.lastname: Mues
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hruby
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Benson
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery*