Introduction and Objectives: Nefroureterectomy with perimeatal cystectomy is still the gold standard in the treatment of urothelial upper urinary tract carcinoma (UUTC). Ureteral endoscopic surgery was proposed as a complementary first step in nephroureterectomy in order to obviate the low abdominal incision. Our goal was to establish the value of a novel method of endoscopic distal ureteral management in one-step nephroureterectomy for UUTC: pluck technique using bipolar plasma vaporization.
Material and Methods: During the last two years, we performed nephroureterectomy with pluck transurethral detachment of the intramural ureter using the bipolar plasma vaporization in 42 cases of UUTC (pTa in 16 cases, pT1 in 10 cases, pT2 in 9 cases and pT3 in 7 cases). The tumor was pyelocaliceal in 34 cases, ureteral in 7 cases and both ureteral and pyelocaliceal in 1 case. The follow-up protocol included cystoscopy with urinary cytology, ultrasonography, intravenous pyelography and CT. The mean follow-up period was 14 months (range 8 to 26 months).
Results: All procedures were successfully completed. The complication rate was 4.8%: 2 cases of hematuria, one imposing endoscopic approach and another one treated conservatively. During follow-up, 6 patients presented bladder recurrences, 1 had renal fossa tumors and 1 had secondary lymph-node invasion. The disease-specific mortality rate was 4.8%.
Conclusions: The endoscopic approach of the terminal ureter with bipolar plasma vaporization as part of one-step nephroureterectomy is a safe, facile and effective method, with good oncological results.
Institution„Saint John” Emergency Clinical Hospital, Bucharest, Romania
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