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Kwon SY, Ko YH, Song PH, Kim BH, Kim BS, Kim TH. The Remaining Ipsilateral Ureteral Orifice Provokes Intravesical Tumor Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multicenter Study With a Mid-Term Follow-Up. Urology 2020; 145:166-171. [DOI: 10.1016/j.urology.2020.06.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
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Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol 2019; 37:2303-2311. [PMID: 31062121 DOI: 10.1007/s00345-019-02790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC). METHODS Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU. RESULTS 81 patients were included. No case required conversion to open surgery. Early major (Clavien-Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3 months was - 1 ml/min/1.73 m2 after SU and - 15 ml/min/1.73 m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21 months and 22 months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease. CONCLUSION Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.
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Jia Z, Gong YQ, Zhang CJ, Bao ZQ, Li XS, Hao H, Xiong GY, Zhang L, Fang D, He ZS, Zhou LQ. Segmental ureterectomy can be performed safely in patients with urothelial carcinoma of distal ureter. Can Urol Assoc J 2018; 13:E202-E209. [PMID: 30472983 DOI: 10.5489/cuaj.5555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to compare oncological outcomes by surgery type (segmental ureterectomy [SU] vs. radical nephroureterectomy [RNU]) in a large cohort of patients with upper tract urothelial carcinoma (UTUC) of the distal ureter. METHODS We performed a retrospective analysis of 219 patients with UTUC of the distal ureter among 931 patients with UTUC who underwent SU and RNU. Clinicopathological outcomes were evaluated. Cancer-specific survival (CSS), overall survival (OS), local recurrence-free survival (RFS), intravesical recurrence-free survival (IVRFS), contralateral recurrence-free survival, and distal metastasis-free survival were assessed by the Kaplan-Meier method and Cox regression, estimating hazard ratios (HR) and 95% confidence intervals (CIs). RESULTS A total of 179 (81.7%) patients underwent RNU and 40 (18.3%) underwent SU: 85 males (47.5%) with RNU and 17 (42.5%) with SU (p=0.568). The median age with RNU and SU was 71 years (range 31-86) and 70 years (range 46-90), respectively (p=0.499). The T stage of the two groups did not differ (p=0.122), nor did mean tumour length (3.35±2.62 vs. 3.25±2.14; p=0.953), grade (p=0.075), tumour necrosis (p=0.634), or followup time (months) (58.1±8.1 vs. 63.7±3.4; p=0.462). The two groups did not differ in CSS (p=0.358) or OS (p=0.206), and surgery type did not predict CSS (HR 0.862; 95% CI 0.469-1.585; p=0.633) or OS (HR 0.764; 95% CI 0.419-1.392; p=0.379). Local RFS was higher with RNU than SU (96.2% vs. 86.0%; p=0.02), but the groups did not differ in IVRFS (p=0.661), contralateral RFS (p=0.183), or distant metastasis-free survival (p=0.078). On multivariate analysis, SU was associated with local RFS (HR 5.069; 95% CI 1.029-24.968; p=0.046) and distant metastasis-free survival (HR 6.497; 95% CI 1.196-35.283; p=0.03). Local RFS was lower with SU than RNU for patients with pT3-4 stage (p=0.006). CONCLUSIONS Long-term oncological outcomes were equivalent with SU and RNU in patients with UTUC of the distal ureter. SU affected local recurrence survival, especially with advanced tumour stage, and distant metastasis survival.
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Affiliation(s)
- Zhuo Jia
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Yan-Qing Gong
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Cui-Jian Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Zheng-Qing Bao
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Xue-Song Li
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Geng-Yan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Zhi-Song He
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
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Papatsoris AG, Chrisofos M, Skolarikos A, Varkarakis I, Lekas A, Dellis A, Koritsiadis S, Deliveliotis C. Upper Urinary Tract Transitional Cell Carcinoma. A 10-year Experience. TUMORI JOURNAL 2018; 94:75-8. [DOI: 10.1177/030089160809400114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To present our 10-year experience with patients surgically treated for upper urinary tract transitional cell carcinoma. Patients and methods We reviewed the medical records of 264 patients (218 males and 46 females), aged 37–93 years (mean, 69.5), treated surgically for upper tract transitional cell carcinoma during the period January 1996 to December 2005. Results During the mean follow-up of 58 months (range, 12–120), local relapse was diagnosed in 14% of the patients. The mean time to recurrence was 13 months (range, 1–102). The overall mortality was 14%, and the mean survival was 109 months. Survival was significantly influenced by the following parameters: male gender (P = 0.0151), age over 80 years (P = 0.0012), location in both the pelviocaliceal system and the ureter (P = 0.051), a two incision operation (P = 0.0075), grade III (P = 0.0314), stage T3 and T4 (P <0.0001). Conclusions Tumor stage was identified as the most important determinant in predicting recurrence and survival. Other predictors of survival included male gender, age over 80 years, location in the pelviocaliceal system and the ureter, a two incision operation, and high grade.
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Affiliation(s)
- Athanasios G Papatsoris
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Michael Chrisofos
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Andreas Skolarikos
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Ioannis Varkarakis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | - Alexandros Lekas
- Department of Urology, General Hospital of Nikea, Piraeus, Greece
| | - Athanasios Dellis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
| | | | - Charalambos Deliveliotis
- Second Department of Urology, School of Medicine, University of Athens, Sismanoglio Hospital, Athens
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Gambachidze D, Phé V, Drouin SJ, Wolff B, Parra J, Mozer P, Renard-Penna R, Chartier-Kastler E, Rouprêt M. [Functional outcomes obtained after vesicoureteral reimplantation surgery in adults: A review]. Prog Urol 2015; 25:683-91. [PMID: 26184044 DOI: 10.1016/j.purol.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 05/31/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Vesico-ureteral reimplantations (VUR) for adults are complex procedures, often practicing for distal ureteral lesions. Our goal was to synthesis the main indications for VUR, different techniques and their functional outcomes. MATERIAL AND METHODS A literature review in English by Medline, Embase and Google scholar was performed using the following keywords: ureter; laparoscopy; robotics, reimplantation; surgery; obstruction; morbidity; complications; psoas hitch; Boari flap; ureteroneocystostomy. RESULTS In more than half of the cases, aetiology was a iatrogenic ureteral lesion. When the ureteral defect was less than 2 cm, direct or non-refluxing VUR was the technique of choice. If defect was superior than 2 cm the Boari flap or vesicopsoas hitch were preferred. Several surgical approaches were feasible: open, laparoscopic only, robot assisted laparoscopic. Estimated blood loss, pain and mean hospital stay seemed better with conventional or robotic coelioscopy. Nevertheless, complications, pre-/post-operative renal function and mean operative time seemed similar. The most frequent major complication was the anastomotic urine leakage. CONCLUSIONS The VUR techniques are well codified now even if it's a rare procedure. Functional outcomes are satisfied according to literature and morbidity is more and more decreasing but the level of evidence of the studies is low.
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Affiliation(s)
- D Gambachidze
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Phé
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S J Drouin
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - B Wolff
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Parra
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Mozer
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Renard-Penna
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Chartier-Kastler
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Rouprêt
- Service d'urologie de l'hôpital Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Risk-adapted strategy for the kidney-sparing management of upper tract tumours. Nat Rev Urol 2015; 12:155-66. [DOI: 10.1038/nrurol.2015.24] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Pignot G, Colin P, Rouprêt M, Traxer O. Traitement conservateur des tumeurs de la voie excrétrices supérieure : revue de littérature systématique pour le rapport scientifique annuel de l’Association française d’urologie. Prog Urol 2014; 24:1011-20. [DOI: 10.1016/j.purol.2014.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 07/17/2014] [Indexed: 01/11/2023]
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Garcia-Segui A, Cáceres F, Angulo J. Response to comments on: Laparoscopic distal ureterectomy for urothelial carcinoma is technically feasible…but is it oncologically safe? Actas Urol Esp 2014; 38:206-7. [PMID: 24296309 DOI: 10.1016/j.acuro.2013.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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García-Segui A, Gómez I, García-Tello A, Cáceres F, Angulo JC, Gascón M. [Ureterectomy in the treatment of urothelial carcinoma of the distal ureter]. Actas Urol Esp 2013; 37:249-55. [PMID: 23398812 DOI: 10.1016/j.acuro.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 09/04/2012] [Accepted: 09/06/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Segmental ureterectomy with preservation of the kidney is a treatment option for the low grade urothelial carcinoma (LG-UC) in distal ureter that is not a candidate for endoscopic resection. Laparoscopic distal ureterectomy (LDU) with ureteral reimplantation is common in benign conditions (stenosis, iatrogenic lesion, endometriosis). However, it has been hardly described in malignant ureteral condition. The literature is reviewed in this regards and the surgical technique described. MATERIAL AND METHODS The experience regarding two cases of LDU due to low grade urothelial carcinoma in distal ureter is presented. In both, previous bladder transurethral resection (RTU) was performed. The urinary cytology was negative and the imaging studies identified urinary obstruction and distal ureter filling defect. One of the patients had a background of T1G3 bladder cancer and suffered renal failure. In both, the ureter was ligated early. Segmental ureterectomy was performed using a combined endoscopic and laparoscopic procedure with ureteral desinsertion in one case. In the other, it was exclusively laparoscopic. Both were done with 4 trocars. Ureteral reimplantation was conducted with continuous hermetic suture and without tension. In one case with background of high grade bladder tumor, pelvic lymphadenectomy was also performed. RESULTS Operating time was 180 and 240 min, respectively, with estimated bleeding of 100 and 250 ml. Hospitalization time was 6 and 4 days. The only post-operatory complication was paralytic ileum (Clavien I) in the first case. With a 20 and 12 month follow-up, there is no evidence of recurrence or dilatation. In the patient with renal failure, creatinine clearance improved. CONCLUSIONS The LDU with ureteral reimplantation is a complex technique. However, it represents a feasible and effective alternative for the treatment of LG-UC in distal ureter, as long as the oncological and reconstructive principles are respected.
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Affiliation(s)
- A García-Segui
- Servicio de Urología, Hospital General Mateu Orfila, Mahón, España.
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Ahn JH, Han JY, Nam JK, Park SW, Lee SD, Chung MK. Laparoscopic ureteroneocystostomy: modification of current techniques. Korean J Urol 2013; 54:26-30. [PMID: 23362444 PMCID: PMC3556550 DOI: 10.4111/kju.2013.54.1.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 10/18/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions. Materials and Methods We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side. Results The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period. Conclusions The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.
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Affiliation(s)
- Jae Hyun Ahn
- Department of Urology, Pusan National University Hospital, Busan, Korea
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McClain PD, Mufarrij PW, Hemal AK. Robot-assisted reconstructive surgery for ureteral malignancy: analysis of efficacy and oncologic outcomes. J Endourol 2012; 26:1614-7. [PMID: 22849289 DOI: 10.1089/end.2012.0219] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE There have been previous reports of the use of robotic technology for the surgical treatment of ureteral neoplasms such as transitional-cell carcinoma. These have lacked long-term follow-up, been isolated cases, or focused on only the distal ureter. This investigation examines a series of mid and distal ureteral neoplasms managed with surgeon controlled robotic techniques at a tertiary care medical center. We present perioperative data and long-term follow-up, with emphasis on oncologic outcomes. PATIENTS AND METHODS This series includes six consecutive patients who have undergone robot-assisted surgical extirpation of mid and distal ureteral malignancies since 2008. Four patients underwent robot-assisted distal ureterectomy with ureteroneocystostomy, and two underwent midureter segmental excision with ureteroureterostomy. Patient demographics, intraoperative data, final pathology results, and oncologic follow-up were reviewed retrospectively. RESULTS Total mean operative time was 268.5 minutes, including the cystoscopy and change of position component of the procedure; mean estimated blood loss was 72.5 mL, and the mean length of stay was 1.8 days. All four patients who underwent distal ureterectomy also had excisions of the ipsilateral bladder cuff-three needed a psoas hitch to facilitate the ureteroneocystostomy. Final pathology results revealed four cases of transitional-cell carcinoma, one case of ureteral carcinoma in situ, and one case of non-Hodgkin diffuse-type B-cell lymphoma. The only complication was a small hydrocele in one patient. All patients underwent standard surveillance protocol, with a recurrence in the bladder developing in one patient. Ureteral obstruction did not develop in any patient postoperatively. Mean length of follow-up was 33 months. CONCLUSIONS Robot-assisted surgery is well suited for the complex reconstruction of the mid and distal ureter after excision of low-grade malignant lesions. This series demonstrates that this surgical approach offers excellent intermediate-term oncologic outcomes with preservation of ipsilateral renal function. We believe that robotic surgery may be considered as a first-line option for the minimally invasive excision and reconstruction of low-grade, localized ureteral malignancy in selected patients at centers with experienced teams.
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Affiliation(s)
- Paul D McClain
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Simonato A, Varca V, Gregori A, Benelli A, Ennas M, Lissiani A, Gacci M, De Stefani S, Rosso M, Benvenuto S, Siena G, Belgrano E, Gaboardi F, Carini M, Bianchi G, Carmignani G. Elective segmental ureterectomy for transitional cell carcinoma of the ureter: long-term follow-up in a series of 73 patients. BJU Int 2012; 110:E744-9. [DOI: 10.1111/j.1464-410x.2012.11554.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Colin P, Ouzzane A, Pignot G, Ravier E, Crouzet S, Ariane MM, Audouin M, Neuzillet Y, Albouy B, Hurel S, Saint F, Guillotreau J, Guy L, Bigot P, De La Taille A, Arroua F, Marchand C, Matte A, Fais PO, Rouprêt M. Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: results from a large French multicentre study. BJU Int 2012; 110:1134-41. [DOI: 10.1111/j.1464-410x.2012.10960.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bird VG, Kanagarajah P. Surgical management of upper tract urothelial carcinoma. Indian J Urol 2011; 27:2-9. [PMID: 21716884 PMCID: PMC3114582 DOI: 10.4103/0970-1591.78400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Upper tract urothelial cell carcinoma accounts for 5% of all urothelial tumors. Compared to lower urinary tract tumors, upper tract urothelial carcinoma is diagnosed more frequently at advanced stages. Open radical nephroureterectomy remains the gold standard treatment option for upper tract tumors. However, with the advancement of minimally invasive techniques and the benefits of these procedures regarding perioperative morbidity, cosmesis, and earlier convalescence, these options have shown promise in managing the patients with upper tract urothelial carcinoma. Despite the perioperative advantages, concerns exist on the oncological safety after minimally invasive surgery. In this article, we provide a comprehensive overview of the surgical management of upper tract urothelial carcinoma.
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Affiliation(s)
- Vincent G Bird
- Department of Urology, University of Miami-Miller School of Medicine, Miami, Florida, USA
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Núñez-Mora C, García-Mediero J, Cabrera P, Hernández E, García-Tello A, Angulo J. [Treatment of distal ureteral stricture by laparoscopic ureterovesical reimplantation]. Actas Urol Esp 2011; 35:31-6. [PMID: 21256392 DOI: 10.1016/j.acuro.2010.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 10/01/2010] [Indexed: 10/26/2022]
Abstract
INTRODUCTION to analyse the results achieved to treat iliac or pelvic ureteric stricture using laparoscopic reimplantation of the ureter in a psoic bladder. MATERIAL AND METHOD in a four-year period, we performed laparoscopic ureteral reimplantation in a psoic bladder in 6 patients (right/left 1:1; male/female 1:2; mean age 59.2 years, range 47-87). In 4 cases the lesion was iatrogenic and in 2 cases idiopathic. Ureteral resection with bladder cuff and cystorraphy followed by ipsilateral lymph node dissection was performed in idiopathic cases or those with history of previous urothelial tumour (4 cases in total) before ureteral reimplantation. Bladder was extensively mobilized and fixed to minor psoas tendon before performing ureteroneocystostomy. Mixed intra and extravesical technique with submucosal tunnel (Politano) was used in a case and in the remaining 5 cases extravesical technique with submucosal tunnel (Goodwin) was used. Mean follow-up was 26 months (range 18-34). RESULTS there was no need to convert to open surgery. Time of surgery was 230 minutes in the case treated with Politano ureteroneocystostomy and 120 (range 75-150) in those treated purely extravesically. The mean hospital stay was 3.2 days (range 2-5). There were no intra or postoperative complications. Histologic assessment always revealed ureteral fibrosis and in 2 cases accompanying granulomatous inflammation and dysplasia. No patient suffered re-stricture or impairment in renal function during follow-up. CONCLUSIONS laparoscopic ureteral reimplantation is an effective and safe minimally invasive technique to treat benign distal stricture of the ureter. Simplicity of extravesical reimplantation has an advantage over its intravesical counterpart.
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Allaparthi S, Ramanathan R, Balaji K. Robotic Distal Ureterectomy with Boari Flap Reconstruction for Distal Ureteral Urothelial Cancers: A Single Institutional Pilot Experience. J Laparoendosc Adv Surg Tech A 2010; 20:165-71. [DOI: 10.1089/lap.2009.0269] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Satya Allaparthi
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Rajan Ramanathan
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - K.C. Balaji
- Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
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Schimpf MO, Wagner JR. Robot-assisted laparoscopic Boari flap ureteral reimplantation. J Endourol 2009; 22:2691-4. [PMID: 19040387 DOI: 10.1089/end.2008.0166] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Creation of a Boari flap is an option for ureteral reimplantation with high transection or stricture of the ureter. The benefits of laparoscopic surgery include decreased blood loss, quicker recovery time, and improved cosmesis. Robot-assisted surgery offers intraoperative advantages, including three-dimensional visualization with magnification and wristed movements with additional degrees of freedom. A 75-year-old woman with a persistent ureteral stricture opted for robot-assisted surgery for definitive management. To optimize the repair with least tension, creation of a Boari flap was chosen intraoperatively. Surgery and recovery were uncomplicated. Robot-assisted laparoscopic surgery can be safely used for Boari flap ureteral reimplantation.
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Affiliation(s)
- Megan O Schimpf
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, Connecticut, USA.
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Kang SG, Choi H, Ko YH, Tae BS, Cho S, Ahn HJ, Chae JY, Kang SH, Cheon J. Robot-Assisted Laparoscopic Distal Ureterectomy and Ureteral Reimplantation. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.9.921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung Gu Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Hoon Choi
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Young Hwii Ko
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Bum Sik Tae
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Hong Jae Ahn
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Ji Yun Chae
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University School of Medicine, Seoul, Korea
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Glinianski M, Guru KA, Zimmerman G, Mohler J, Kim HL. Robot-Assisted Ureterectomy and Ureteral Reconstruction for Urothelial Carcinoma. J Endourol 2009; 23:97-100. [DOI: 10.1089/end.2007.0279] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michal Glinianski
- Department of Urologic Oncology, Roswell Park Cancer Institute and State University of New York, Buffalo, New York
| | - Khurshid A. Guru
- Department of Urologic Oncology, Roswell Park Cancer Institute and State University of New York, Buffalo, New York
| | - Greg Zimmerman
- Department of Urologic Oncology, Roswell Park Cancer Institute and State University of New York, Buffalo, New York
| | - James Mohler
- Department of Urologic Oncology, Roswell Park Cancer Institute and State University of New York, Buffalo, New York
| | - Hyung L. Kim
- Department of Urologic Oncology, Roswell Park Cancer Institute and State University of New York, Buffalo, New York
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Rouprêt M, Smyth G, Irani J, Guy L, Davin JL, Saint F, Pfister C, Wallerand H, Rozet F. Oncological risk of laparoscopic surgery in urothelial carcinomas. World J Urol 2008; 27:81-8. [DOI: 10.1007/s00345-008-0349-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022] Open
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21
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[Endosopic organ-sparing treatment of urothelial tumors of the upper urinary tract: indications and results]. Urologe A 2008; 47:830, 832-7. [PMID: 18560800 DOI: 10.1007/s00120-008-1714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In addition to radical nephrourterectomy with removal of the bladder cuff, which is still the gold standard in the therapy of urothelial tumors of the upper urinary tract, various percutaneous and transurethral endoscopic methods are now well established for organ-sparing therapies due to technical improvements in endoscopy. Although these were originally only used with selective indications, if radical nephrourterectomy were not coupled with an unreasonable postoperative morbidity (e.g. dialysis-dependence after removal of a tumor-carrying single kidney), organ-sparing therapy attempts are increasingly more recommended, even by extended indications. Analysis of the current literature shows that organ-sparing is strived for, especially with small (<1.5 cm) solitary urothelial tumors with low grade malignancy and without muscle invading growth. Although tumor-specific survival with 69-100% is comparable to nephrourterectomy, organ-sparing treatment appears more inclined to tumor recurrence (relapse rate 23-90%). These data must, however, be interpreted with caution because they originate from retrospective single center studies with low patient numbers, very different patient collectives and mostly relatively short follow-up time periods. Prospective randomized multicenter studies with large patient collectives and long follow-up times are not yet available. After organ-sparing therapy of urothelial tumors of the upper urinary tract, it is important to have life-long follow-up with imaging and endoscopy, in order to initiate an early second therapy in the case of a relapse.
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Irani J, Bernardini S, Bonnal JL, Chauvet B, Colombel M, Davin JL, Laurent G, Lebret T, Maidenberg M, Mazerolles C, Pfister C, Roupret M, Roy C, Rozet F, Saint F, Theodore C. [Urothelial tumors]. Prog Urol 2008; 17:1065-98. [PMID: 18153988 DOI: 10.1016/s1166-7087(07)74781-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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23
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Raman JD, Scherr DS. Management of patients with upper urinary tract transitional cell carcinoma. ACTA ACUST UNITED AC 2007; 4:432-43. [PMID: 17673914 DOI: 10.1038/ncpuro0875] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 06/12/2007] [Indexed: 12/13/2022]
Abstract
Multiple therapeutic options are available for the management of patients with upper urinary tract transitional cell carcinoma (TCC). Radical nephroureterectomy with an ipsilateral bladder cuff is the gold-standard therapy for upper-tract cancers. However, less invasive alternatives have a role in the treatment of this disease. Endoscopic management of upper-tract TCC is a reasonable strategy for patients with anatomic or functional solitary kidneys, bilateral upper-tract TCC, baseline renal insufficiency, and significant comorbid diseases. Select patients with a normal contralateral kidney who have small, low-grade lesions might also be candidates for endoscopic ablation. Distal ureterectomy is an option for patients with high-grade, invasive, or bulky tumors of the distal ureter not amenable to endoscopic management. In appropriately selected patients, outcomes following distal ureterectomy are similar to that of radical nephroureterectomy. Bladder cancer is a common occurrence following the management of upper-tract TCC. Currently, there are no variables that consistently predict which patients will develop intravesical recurrences. As such, surveillance with cystoscopy and cytology following surgical management of upper-tract TCC is essential. Extrapolating from data on bladder TCC, both regional lymphadenectomy and neoadjuvant chemotherapy regimens are likely to be beneficial for patients with upper-tract TCC, particularly in the setting of bulky disease.
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Affiliation(s)
- Jay D Raman
- Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10021, USA
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