Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy?

作者：Phe Veronique; Cussenot Olivier; Bitker Marc Olivier; Roupret Morgan^*

来源：BJU International, 2011, 108(1): 130-138.

DOI：10.1111/j.1464-410X.2010.09835.x

• upper urinary tract urothelial carcinoma
• bladder cuff
• nephroureterectomy
• laparoscopic
• pluck technique
• ureteral intususseption
• robotics
• outcomes

The standard treatment of upper urinary tract urothelial carcinomas (UUT-UCs) must obey oncological principles, which consist of a complete en bloc resection of the kidney and the ureter, as well as excision of a bladder cuff to avoid tumour seeding.
The open technique is the 'gold standard' of treatment to which all other techniques developed are necessarily compared, and various surgical procedures have been described.
The laparoscopic stapling technique maintains a closed system but risks leaving behind the ureteric and bladder cuff segments.
Transvesical laparoscopic detachment and ligation is a valid approach from an oncological stance but is technically difficult. The major inconvenience of the transurethral resection of the ureteric orifice and intussusception techniques is the potential for tumour seeding.
Management of the distal ureter via the robot-assisted laparoscopic method is technically feasible, but outcomes from these procedures are still preliminary.
Therefore, prospective comparative studies with more thorough explorations of these techniques are needed to solve the dilemma of the management of the distal ureter during nephroureterectomy. However, bladder cuff excision should remain the standard of care irrespective of the stage of the disease.

• 出版日期2011-7