title: Is hand-assisted retroperitoneoscopic nephroureterectomy better than transurethral bladder cuff incision-assisted nephroureterectomy?
abstract: OBJECTIVE
  To compare the perioperative and oncologic outcome between hand-assisted nephroureterectomy (HARNU) and transurethral bladder cuff incision-assisted nephroureterectomy (TUINU), which manage the bladder cuff with different methods.
  
  
  METHODS
  From January 2005 to December 2008, 325 patients with upper urinary tract urothelial carcinoma (UUT-UC) underwent nephroureterectomy at our institution. A total of 208 patients were enrolled in this retrospective study.
  
  
  RESULTS
  A total of 208 patients, including 102 men and 106 women, were analyzed in this retrospective study. Ninety-eight patients underwent HARNU for UUT-UC, and110 patients underwent TUINU. The HARNU group has less operative time and hospital stay, and fewer postoperative ileus episodes. There were trends of less blood loss in the HARNU group. There were no statistical differences in the total bladder tumor recurrence, local recurrence, contralateral recurrence, distant metastasis, and cancer-specific survival between HARNU and TUINU. There was a significantly higher incidence of bladder tumor recurrence in TUINU group, however, than in the HARNU group (P=0.008) if the tumor was located at the low third of the ureter.
  
  
  CONCLUSIONS
  There were more oncologic concerns about bladder tumor recurrence for the low third ureteral tumor in the TUINU group. In addition, the perioperative outcomes such as operative time, blood loss, hospital stay, and ileus rate were better in the HARNU group. Therefore, surgeons can manage UUT tumor with less oncologic concern and better perioperative results with HARNU.
authors.affiliation: Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. alesy@adm.cgmh.org.tw
authors.forename: Po Hui
authors.initials: PH
authors.lastname: Chiang
authors.forename: Hao Lun
authors.initials: HL
authors.lastname: Luo
authors.forename: Yen Ta
authors.initials: YT
authors.lastname: Chen
authors.forename: Chih Hsiung
authors.initials: CH
authors.lastname: Kang
authors.forename: Yao Chi
authors.initials: YC
authors.lastname: Chuang
authors.forename: Wei-Ching
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*