Nephroureterectomy With Ureteral Orifice Excision By Retroperitoneal Laparoscopy And Urethral Resectoscope For Upper Urinary Tract Carcinoma

Objective To investigate the clinical outcomes of retroperitoneoscopicnephroureterectomy with excision of a bladder-cuff for upper urinarytract carcinoma. Methods106patients(60men and46wemen,mean age63years,age range,43-78years) with upper urinary tract transitional cellcarcinoma(75cases in renal pelvis,17in the upper ureter and5in themiddle ureter and9in the low ureter,but one of which was combined withbladder carcinoma).We insert the ureter catheter under the retrogrademotion using the cystoscope in order to drain the renal pelvis urine. Theneedle electrode was used to circleround incise the bladder thoroughly0.5cm away from the ureterostoma,dissected the joint of opening of theureter and bladder.Then pull out the ureter catheter,congeal and close theopening of the ureter to reduce the opportunity of the tumor cellsspread.Three trocars in the waist were used for dissecting the kidney,andthe ureter was dissected as far distally downward.If the tumor was in therenal pevis or the upper ureter,we could use the pliers to pull out thedown ureter,enlarged the cuff cut,then took out the renal and the wholeureter,so we could avoid the abdomen cut. If the next segment ureteraltumor, incision is required hypogastric minister about5~7cm, kidneyremoved incision, along the ureter to bladder downward free electricincision length, complete removal of kidney and ureter, and lower ureteral resection, this can reduce the tumor or metastasis. Results All106operation procedures were successfully performed without sverecomplication.The mean operation time was120minutes.The meanhemorrhage was60ml(40-500),one needed blood transfusion.The meantime with drainage and Foley catheter were4days(3-7) and8days(7-15),all the patients were given the type-B ultrasonic to evaluatethe leakage of urine around the bladder.All the pathological report wereurinary tract urothelial cell carcinomas. In106patients The follow uptime ranged from3to38months(mean18month).95cases weresurvivalled without tumors,5died to the cadiovascular disease andpulmonary disease,6cases with tumor of bladder underwent the TUR.Conclusions Retroperitoneoscopic nephroureterectomy with excision of abladder-cuff for upper urinary tract carcinoma was safe and easy going,The needle electrode was used to circleround incise the bladderthoroughly the joint of opening of the ureter and bladder,which cancompletely excise the ureter.Then pull out the ureter catheter,congeal andclose the opening of the ureter through electric coagulation to reduce theopportunity of the tumor cells spread.What’s more,when the tumor in therenal pelvis and upper ureter can avoid the abdomen incision,which canreduce the trauma effectively with a dependable effect and no tumorimplantation metastasis.