Intravesical sealing of the distal ureter in nephroureterectomy.
| Autor: | Sesmero JH; Urology Department. University Hospital Rio Hortega. Valladolid. Spain. amonsesmero@yahoo.es, Redondo CC, Delgado MC, Royo FC, Tesedo VR, Oceja JM |
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| Jazyk: | English; Spanish; Castilian |
| Zdroj: | Archivos espanoles de urologia [Arch Esp Urol] 2010 Apr; Vol. 63 (3), pp. 223-9. |
| Abstrakt: | Objectives: To study the effectiveness and reliability of a new minimally invasive technique for the treatment of the terminal ureter in nephroureterectomy due to transitional cell carcinoma, both in open and laparoscopic procedures. Methods: Observational retrospective study of 14 patients that underwent intravesical sealing and endoscopic excision of terminal ureter, before ureterectomy (11 laparoscopic, 3 open), due to an upper urinary tract tumor, between July 2003 and November 2007. This procedure was performed on 11 males and 3 females, average age 59.5 years, )range: 35-70). The tumor settled on the renal pelvis in 12 cases and on the proximal ureter in 2. Stage was Ta - T1 in 10 patients, T2 in 3, and T3 in 1. Tumor grade was G3 in 9 cases and G2 in 5. Excision was carried out with a Collins knife. In order to avoid contact between the urine and retroperitoneal space, the meatus was quickly sealed with a clip introduced by means of a transvesical trocar. Results: Total surgical time of nephroureterectomy was 231.15 minutes (range 200-340). Global complication rate for the procedure was 28.4%, but the rate for the cases associated with this technique (meatus sealing and disinsertion) was 14.2%. All patients were discharged after removing bladder catheter. Mean hospital stay was 10.14 days (range: 6-22). After an average follow-up of 25.3 months (range: 12-64), no retroperitoneal recurrence has been reported. One of the patients had bladder recurrence and another one developed metastasis to the suprarenal gland that was treated satisfactorily. Conclusions: Quick sealing of distal ureter by transvesical application of a clip before its endoscopic excision in nephrourecterectomy is a sound technique from an oncological point of view, with an acceptable complication rate that avoids a second open time to manage distal ureter. |
| Databáze: | MEDLINE |
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