Abstract
Open radical nephroureterectomy (NU) with removal of the ureter and bladder cuff is the ‘gold standard’ in the treatment of high-grade urothelial cancers of the upper urinary tract. A salient issue is the management of the distal ureter and bladder cuff at time of surgery. Which technique confers superior oncologic benefit is of particular interest since this disease process is notoriously plagued with high intravesical recurrence rates. Although open radical NU is the ‘gold standard’, the maturation of minimally invasive surgery formidably challenges approaches considered ‘gold standard’. We thus sought to critically review the literature comparing perioperative and oncologic outcomes in the approaches used to manage the distal ureter and bladder cuff in patients undergoing radical NU.
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1. . Upper-tract transitional cell carcinoma. Urology 50(3), 321–329 (1997).
- 2. . Distal ureterectomy techniques in laparoscopic and robot-assisted nephroureterectomy: updated review. Urol. Ann. 7(1), 8–16 (2015).
- 3. . Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy? BJU Int. 108(1), 130–138 (2011).
- 4. . Urothelial tumors of the upper urinary tract and ureter. In: Campbell–Walsh Urology, 11th Edition. Elsevier Saunders, PA, USA, 1365–1402 (2016).
- 5. . Open nephroureterectomy. In: Urothelial Malignancies of the Upper Urinary Tract: A Textbook of Step by Step Management. Eshghi M (Ed.). Springer, Switzerland, 179–184 (2018).
- 6. . A novel approach for a complete laparoscopic nephroureterectomy with bladder cuff excision. J. Endourol. 24(3), 415–419 (2010).
- 7. . Transurethral resection of the intramural ureter as the first step of nephroureterectomy. J. Urol. 154(1), 43–44 (1995).
- 8. . A novel technique for management of the en bloc bladder cuff and distal ureter during laparoscopic nephroureterectomy. J. Urol. 161(2), 430–434 (1999).
- 9. . Hand-assisted laparoscopic nephroureterectomy with cystoscopic en bloc excision of the distal ureter and bladder cuff. J. Endourol. 16(6), 329–332; discussion 332–323 (2002).
- 10. Transurethral distal ureter balloon occlusion and detachment: a simple means of managing the distal ureter during radical nephroureterectomy. J. Endourol. 27(2), 139–142 (2013).
- 11. . Bipolar plasma vaporization – an innovative intramural ureter detachment method during nephroureterectomy. J. Med. Life. 5(2), 153–156 (2012).
- 12. . A new 2-micrometer continuous wave laser method for management of the distal ureter in retroperitoneal laparoscopic nephroureterectomy. J. Endourol. 29(4), 430–434 (2015).
- 13. . Robot-assisted laparoscopic nephroureterectomy. J. Endourol. 20(7), 463–465; discussion 465–466 (2006).
- 14. . Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning. Urology 78(2), 357–364 (2011).
- 15. . Robot-assisted radical nephroureterectomy with extended template lymphadenectomy for upper tract urothelial carcinoma: an outcome analysis. Indian J. Urol. 34(3), 212–218 (2018).
- 16. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur. Urol. 57(6), 963–969 (2010).
- 17. . Treatment of upper tract urothelial carcinoma with ureteroscopy and thulium laser: a retrospective single center study. BMC Cancer 18(1), 196 (2018).
- 18. Comparative study of ureteral stripping versus open ureterectomy for nephroureterectomy in patients with transitional carcinoma of the renal pelvis. Urology 63(5), 848–852 (2004). • Demonstrates the inferiority of stripping in certain patients compared with other methods.
- 19. . Endoscopic ureteral procedures for one-step nephroureterectomy: experience in 100 cases. J. Endourol. 21(9), 1019–1024 (2007).
- 20. . Hand-assisted laparoscopic nephroureterectomy: analysis of distal ureterectomy technique, margin status, and surgical outcomes. Urology 66(6), 1192–1196 (2005).
- 21. . Oncologic outcomes of extravesical stapling of distal ureter in laparoscopic nephroureterectomy. J. Endourol. 21(9), 1025–1027 (2007).
- 22. . Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J. Urol. 163(4), 1100–1104 (2000).
- 23. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur. Urol. 56(3), 520–526 (2009).
- 24. Comparison of distal ureteral management strategies during laparoscopic nephroureterectomy. J. Endourol. 25(7), 1149–1154 (2011).
- 25. Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur. Urol. 65(1), 210–217 (2014). • One of the largest retrospective reviews on this subject.
- 26. Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool. Eur. Urol. 65(3), 650–658 (2014). • This is a useful nomogram for clinicians to use in predicting intravesical recurrence after surgery.
- 27. Intermediate-term outcomes of robot-assisted laparoscopic nephroureterectomy in upper urinary tract urothelial carcinoma. Clin. Genitourin. Cancer 11(4), 515–521 (2013).
- 28. . Comparison of oncological and perioperative outcomes of open, laparoscopic, and robotic nephroureterectomy approaches in patients with non-metastatic upper-tract urothelial carcinoma. PLoS ONE 14(1), e0210401 (2019). • Demonstrated the noninferiority of robotic approaches to nephroureterectomy.
- 29. Robot-assisted versus laparoscopic nephroureterectomy for upper-tract urothelial cancer: a population-based assessment of costs and perioperative outcomes. Can. Urol. Assoc. J. 8(9–10), e695–e701 (2014).
- 30. . Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review. BJU Int. 110(10), 1426–1435 (2012).
- 31. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease. World J. Urol. 35(3), 327–335 (2017). •• International guideline committee statements in the treatment of this disease, analyzing much of the evidence outlined in this review.
- 32. et al. Nephroureterectomy with or without bladder cuff excision for localized urothelial carcinoma of the renal pelvis. Eur. Urol. Focus
doi:10.1016/j.euf.2018.09.007 (2018) (Epub ahead of print). - 33. Should bladder cuff excision remain the standard of care at nephroureterectomy in patients with urothelial carcinoma of the renal pelvis? A population-based study. Eur. Urol. 57(6), 956–962 (2010).