INTRODUCTION: Although laparoscopic nephroureterectomy is an accepted procedure for treatment of urothelial carcinoma of the renal pelvis or middle and proximal ureter, the way to perform the distal ureterectomy next to the perimeatic bladder mucosa is controversial. The purpose of this study was to test the efficacy of a technique that is designed to destroy the ureteral mucosa and the bladder perimeatic mucosa through thermal ablation.
METHODS: A total of 27 patients with urothelial neoplasm were treated. The mean size of the tumors was 3.2 cm (range, 0.3-6 cm). Urinary cytology was positive and none of the tumors were classified as low-grade malignancy. All patients had thermal ablation of the distal ureter and perimeatic bladder mucosa with a Bugbee electrode through a cystoscope. The electrode was introduced 6 cm into the distal ureteral lumen and then extracted by a continuous rotating movement, with a 40 watt electrocoagulation power administered at the rate of 3 seconds per cm. The perimeatal mucosa was fulgurated with the same electrode, and the laparoscopic nephroureterectomy was performed.
RESULTS: There were no intraoperative complications. The mean follow-up period was 5.2 years (range, 3 months to 14 years). Three patients died from the progression of their disease. Of the remaining 24 patients, 9 had urothelial neoplasm recurrences in the bladder; none were in the ureteral trunnion or perimeatal mucosa. The other 15 patients were asymptomatic and disease-free at their final evaluation.
CONCLUSION: Thermal ablation of the distal ureteral mucosa simplifies the technique of laparoscopic nephroureterectomy for renal pelvic carcinoma and decreases the risk of cancer cell dissemination.
José Gabriel Valdivia-Uría
KEYWORDS: Ureteral laparoscopic detachment; Laparoscopic nephroureterectomy; Renal pelvic carcinoma.
CORRESPONDENCE: Prof. José Gabriel Valdivia-Uría, MD, Urbanización Santa Fe, calle 4a, no 13, Cuarte de Huerva 50410, Zaragoza, Spain ( ).
CITATION: UroToday Int J. 2010 Apr;3(2)
doi: 10.3834/uij.1944-5784.2010.04.12