[Joint therapy of native upper tract transitional cell carcinoma ipsilateral to a transplanted kidney by retroperitoneoscopic nephroureterectomy combined with a midline lower abdominal transperitoneal excision].
OBJECTIVE
To present the preliminary experience of the operative procedure and clinical outcomes of retroperitoneal laparoscopic  nephroureterectomy (RPLNU) with a midline lower abdominal transperitoneal incision for native upper urinary tract transitional cell carcinoma (UUT-TCC)  ipsilateral to a transplanted kidney.


METHODS
In the study, 15 renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated  on with RPLNU via a midline lower abdominal transperitoneal incision between November 2005 and January 2009. Retroperitoneal laparoscopic  nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-8 cm midline lower abdominal  incision was made. The distal ureter was dissected transperitoneally into the intramural segment and extracted completely. The intact specimen was  removed manually via the same incision. The cystostomy was generally sutured.


RESULTS
The mean operation time was 253 minutes. The mean  estimated blood loss was 245 mL. Three patients needed blood transfusion. No open conversion was required during the retroperitoneoscopic  nephrectomy. Two of the patients suffered from minor complications. The pathological findings confirmed UUT-TCC in all the patients with 9 of the  pelvises and 9 of the ureters. Five of the patients were involved with bladder TCC. With the mean follow-up of 35 months, none of them had retroperitoneal  recurrence or distant metastasis, 2 of the 5 patients with bladder TCC had recurrence in bladder and 4 had contralateral native UUT-TCC after the first  unilateral nephroureterectomy.


CONCLUSIONS
RPLNU with a midline lower abdominal transperitoneal incision may be a safe and feasible alternative for  native UUT-TCC ipsilateral to a transplanted kidney with satisfactory oncologic outcomes.
Department of Urology, Peking University Third Hospital, Beijing, China.
Jian-fei
JF
Ye
Lu-lin
LL
Ma
Yi
Y
Huang
Chun-lei
CL
Xiao
Xiao-fei
XF
Hou
Lei
L
Zhao
Guo-liang
GL
Wang
Jian
J
Lu
Kai
K
Hong
Xiao-jun
XJ
Tian
D000005:Abdomen / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000601:surgery*