Radical cystectomy, hysterectomy with double adnexectomy and bilateral nephroureterectomy with transvaginal extraction.
OBJECTIVE
The onset of synchronous urothelial carcinoma in the upper or lower urinary tract is uncommon. Even more uncommon is the onset the bilateral form. The aim of this article is to describe the surgical technique of complete laparoscopic exeresis of the urinary apparatus and to add several variants of the technique that improve the patient's hemodynamics during surgery.


METHODS
We present the technique of cystectomy with bilateral nephroureterectomy, hysterectomy with double adnexectomy and bilateral ilio-obturator lymphadenectomy by laparoscopy and transvaginal extraction of specimens from a 58-year-old patient with multiple prior vesical resections of high-grade urothelial carcinoma. The patient currently presents bladder recurrence and bilateral ureteropelvic tumor. The technique consists first of the hysterectomy and double adnexectomy along with the lymphadenectomy and cystectomy, maintaining the urethrovesical, ureterovesical and uterovaginal junctions. After changing the patient's position, both nephroureterectomies were performed. Lastly, we completed the resection of the previously mentioned segments to extract the specimens transvaginally.


RESULTS
The histological result was high-grade urothelial carcinoma that affected the bladder and both ureteropelvic junctions, along with endometrial carcinoma. After reviewing the literature, we found less than 10 cases in which complete exeresis of the urinary apparatus was performed and none with the technical description presented in this article. In most cases described in the literature, surgery was performed at 2 separate times and without preserving renal function until the end of the complete exeresis.


CONCLUSIONS
This technique helps maintain diuresis for a longer time during surgery and thereby facilitates the work of the anesthesiologist and improves the patient's circulatory dynamics. Additionally, the technique prevents any type of handling of the urinary tract, thereby avoiding the passage of tumor cells to the peritoneal cavity, given that the specimens are extracted whole through the vagina.
UGC Urología, Hospital de Jerez del SAS, Jerez, España.
A
A
Juarez-Soto
UGC Urología, Hospital de Jerez del SAS, Jerez, España.
J M
JM
Arroyo-Maestre
UGC Urología, Hospital de Jerez del SAS, Jerez, España.
M
M
Soto-Delgado
UGC Anestesiología, Hospital de Jerez del SAS, Jerez, España.
M
M
de Paz-Suarez
UGC Urología, Hospital de Jerez del SAS, Jerez, España.
P
P
Beardo-Villar
Asesor Científico UGC Urología, Hospital de Jerez del SAS, Universidad de Granada, Jerez, España. Electronic address: arrabalp@ono.com.
M A
MA
Arrabal-Polo
D000290:Adnexa Uteri / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D014565:Urogenital Neoplasms / Q000601:surgery*; D014621:Vagina
Cirugía laparoscópica; Cistectomía; Cystectomy; Doble nefroureterectomía; Double nephroureterectomy; Laparoscopic surgery; Surgical technique; Técnica quirúrgica