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Lee CU, Lee JH, Lee HW, Chung JH, Song W, Kang M, Jeon HG, Jeong BC, Seo SI, Jeon SS, Sung HH. Analysis of progression after elective distal ureterectomy and effects of salvage radical nephroureterectomy in patients with distal ureteral urothelial carcinoma. Sci Rep 2024; 14:3497. [PMID: 38347103 PMCID: PMC10861547 DOI: 10.1038/s41598-024-54232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/10/2024] [Indexed: 02/15/2024] Open
Abstract
We compared the progression patterns after radical nephroureterectomy (RNU) and elective distal ureterectomy (DU) in patients with urothelial carcinoma of the distal ureter. Between Jan 2011 and Dec 2020, 127 patients who underwent RNU and 46 who underwent elective DU for distal ureteral cancer were enrolled in this study. The patterns of progression and upper tract recurrence were compared between the two groups. Progression was defined as a local recurrence and/or distant metastasis after surgery. Upper tract recurrence and subsequent treatment in patients with DU were analyzed. Progression occurred in 35 (27.6%) and 10 (21.7%) patients in the RNU and DU groups, respectively. The progression pattern was not significantly different (p = 0.441), and the most common progression site was the lymph nodes in both groups. Multivariate logistic regression analysis revealed that pT2 stage, concomitant lymphovascular invasion, and nodal stage were significant predictors of disease progression. Upper tract recurrence was observed in nine (19.6%) patients with DU, and six (66.7%) patients had a prior history of bladder tumor. All patients with upper tract recurrence after DU were managed with salvage RNU. Elective DU with or without salvage treatment was not a risk factor for disease progression (p = 0.736), overall survival (p = 0.457), cancer-specific survival (p = 0.169), or intravesical recurrence-free survival (p = 0.921). In terms of progression patterns and oncological outcomes, there was no difference between patients who underwent RNU and elective DU with/without salvage treatment. Elective DU should be considered as a therapeutic option for distal ureter tumor.
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Affiliation(s)
- Chung Un Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Gyeonggi-do, Republic of Korea
| | - Jong Hoon Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Hye Won Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Nakamura M, Tanaka K, Hayashi S, Morisada T, Iwata T, Imanishi N, Aoki D. Local anatomy around terminal ureter related to the anterior leaf of the vesicouterine ligament in radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 2019; 235:66-70. [PMID: 30798083 DOI: 10.1016/j.ejogrb.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Radical hysterectomy is performed for invasive cervical cancer. In this surgery, separation of the anterior leaf and posterior leaves of the vesicouterine ligament (VUL) is important. We studied the local anatomy of the anterior leaf of the VUL, especially the branches of the umbilical artery from the view point of surgery and cadaver dissection. STUDY DESIGN We observed the cervicovesical blood vessels and the connective tissue layer continued from umbilical artery and searched for the origin of the cervicovesical blood vessels in radical hysterectomy. We also dissected a formalin-fixed female cadaver, and observed the same points. RESULTS After separation of the connective tissue of urinary bladder from the cervical fascia, we could discern the outline of the distal ureter near the ureterovesical junction. We separate the connective tissue of the so-called anterior leaf of the VUL enwrapping the ureter gently, and then the ureter with the connective tissue is completely rolled out laterally. We identified a cervicovesical vessel crossing over the ureter. We looked for the central side of the cervicovesical vessel and found that cervicovesical vessel was a branch of the superior vesical artery. And, during cadaver dissection, we found that the connective tissue and the branches of the superior vesical artery were similarly observed. CONCLUSIONS We found the precise anatomy of the connective tissue layer from umbilical artery to urinary bladder and the superior vesical artery. Our procedure based on the precise anatomy obtained in this study is reasonable anatomically as a method for separation of the vesicouterine ligament during radical hysterectomy.
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Affiliation(s)
- Masaru Nakamura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan.
| | - Kyoko Tanaka
- Department of Obstetrics and Gynecology, Toho University School of Medicine, Japan
| | - Shigenori Hayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Nobuaki Imanishi
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
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Fragkoulis C, Pappas A, Papadopoulos GI, Stathouros G, Fragkoulis A, Ntoumas K. Transurethral resection versus open bladder cuff excision in patients undergoing nephroureterectomy for upper urinary tract carcinoma: Operative and oncological results. Arab J Urol 2017; 15:64-67. [PMID: 28275521 PMCID: PMC5329723 DOI: 10.1016/j.aju.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/06/2016] [Accepted: 12/18/2016] [Indexed: 01/15/2023] Open
Abstract
Objectives To evaluate the impact of distal ureter management on oncological results after open nephroureterectomy (ONU) comparing transurethral resection of the intramural ureter to conventional open excision, as controversy still exists about the method of choice for managing the distal ureter and bladder cuff during ONU. Patients and methods We retrospectively collected data from 378 patients who underwent ONU for upper urinary tract transitional cell carcinoma (UUT-TCC) from 1988 to 2009. Patients were divided into two subgroups according to the type of operation performed. Group A comprised 192 patients who had ONU with open resection of the bladder cuff from 1988 to 1997. Group B comprised 186 patients in whom transurethral resection of the intramural ureter plus single incision ONU was performed between 1998 and 2009. The mean operative time, hospital stay, duration of catheterisation, bladder recurrence rates, and cancer-specific survival (CSS) were assessed. Results The total operative time was statistically significantly less in the endoscopic group (Group B). For catheterisation, patients treated with an open approach (Group A) had a statistically significantly shorter duration of postoperative catheterisation. There was no statistical difference between Groups A and B for the bladder recurrence rate (Group A 24% vs 27% in Group B, P = 0.51). There was no difference in CSS at the 5-year follow-up. Conclusions ONU with transurethral resection of the intramural ureter up to the extravesical fat followed by ureter extraction is an oncologically safe and technically feasible operation.
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Affiliation(s)
| | - Athanasios Pappas
- Department of Urology, Athens General Hospital 'G. Gennimatas', Athens, Greece
| | | | - Georgios Stathouros
- Department of Urology, Athens General Hospital 'G. Gennimatas', Athens, Greece
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Yalcin S, Ertunc M, Ardicli B, Kabakus IM, Tas TS, Sara Y, Onur R, Karnak I. Ureterovesical junction obstruction causes increment in smooth muscle contractility, and cholinergic and adrenergic activity in distal ureter of rabbits. J Pediatr Surg 2013; 48:1954-61. [PMID: 24074674 DOI: 10.1016/j.jpedsurg.2013.01.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/01/2012] [Accepted: 01/14/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE The controversy in management of primary obstructed megaureter necessitates further elucidation of the underlying pathophysiology. We evaluated smooth muscle contractility, and cholinergic, adrenergic and serotonergic activity of rabbit distal ureters after ureterovesical junction (UVJ) obstruction. METHODS Sham (SH) operation, partial obstruction (PO) and complete obstruction (CO) of the right UVJ were performed in rabbits. Three weeks later, distal ureters were isolated; spontaneous contractions (SC), contractile responses to electrical field stimulation (EFS), high KCl, carbachol, phenylephrine and serotonin were recorded. RESULTS SC amplitudes increased in CO compared to PO and SH (p<0.001). SC frequency was higher in CO (p<0.05). EFS-induced contraction amplitudes were greater in CO than other groups (p<0.05). High KCl-induced contractions were greater in CO (p<0.001) and PO (p<0.01). Carbachol-induced contractility was enhanced in CO and PO (p<0.05). Contractile response to phenylephrine was greater in CO than other groups (p<0.05). Serotonin induced contractile responses in CO and PO, greater in CO (p<0.05). UVJ obstruction also increased spontaneous contractility in contralateral PO and CO ureters. CONCLUSIONS UVJ obstruction increased spontaneous and neurotransmitter-induced contractions in an obstruction grade-dependent manner. Obstruction also altered contractility of the contralateral ureters. Our findings may serve to provide further understanding of the pathophysiology of megaureter.
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Affiliation(s)
- Sule Yalcin
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, 06100 Turkey.
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Yapanoglu T, Kocaturk H, Polat O, Demirel A, Okyar G. Endoscopic versus open approach of bladder cuff and distal ureter in the management of upper urinary tract transitional cell carcinoma. Eurasian J Med 2008; 40:124-126. [PMID: 25610045 PMCID: PMC4261665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE Nephroureterectomy with the removal of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment for upper urinary tract urothelial cancer. The distal ureter can be removed with the open surgical technique or endoscopic approach. We compared the outcomes of the endoscopic approach with those of conventional open surgery on the distal ureter. MATERIALS AND METHODS We collected data from the charts of 30 patients who underwent radical nephroureterectomy at our clinic from January 1997 to January 2007 for upper urinary tract urothelial carcinoma. The patients were divided into two groups according to procedure performed on the distal ureter. Group I (n:12) was comprised of patients who underwent an open surgical procedure, and group II (n:18), was comprised of patients who underwent an endoscopic approach. Both groups were compared in terms of operative time, blood loss, transurethral catheter duration and duration of hospital stay. RESULTS Patient age and tumor location showed no significant differences between the two groups. The operative time was significantly longer in group I than group II (181 versus 128 minutes; p<0.05). On the other hand, the estimated blood loss, transurethral catheter duration and duration of hospital stay were significantly lower in group II (205 mL versus 435 mL, 5 versus 8.5 days and 5.6 versus 9.2 days, respectively; p <0.05). CONCLUSION The results of our study show that the endoscopic approach is less invasive than open surgery on the distal ureter. This procedure can easily be performed in the management of upper urinary tract urothelial carcinoma.
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Affiliation(s)
- Turgut Yapanoglu
- Atatürk University, Faculty of Medicine, Department of Urology, Erzurum, Turkey
| | - Huseyin Kocaturk
- Atatürk University, Faculty of Medicine, Department of Urology, Erzurum, Turkey
| | - Ozkan Polat
- Atatürk University, Faculty of Medicine, Department of Urology, Erzurum, Turkey
| | - Azam Demirel
- Atatürk University, Faculty of Medicine, Department of Urology, Erzurum, Turkey
| | - Guray Okyar
- Atatürk University, Faculty of Medicine, Department of Urology, Erzurum, Turkey
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