We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine

Management of distal ureter and bladder cuff at the time of nephroureterectomy: surgical techniques and predictors of outcome

    Kyrollis Attalla

    Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

    ,
    Shyam Patnaik

    Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

    ,
    Ted Vellos

    Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

    &
    Reza Mehrazin

    *Author for correspondence:

    E-mail Address: reza.mehrazin@mountsinai.org

    Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

    Published Online:https://doi.org/10.2217/fon-2019-0064

    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. Tawfiek ER, Bagley DH. Upper-tract transitional cell carcinoma. Urology 50(3), 321–329 (1997).
    • 2. Stravodimos KG, Komninos C, Kural AR, Constantinides C. Distal ureterectomy techniques in laparoscopic and robot-assisted nephroureterectomy: updated review. Urol. Ann. 7(1), 8–16 (2015).
    • 3. Phé V, Cussenot O, Bitker MO, Rouprêt M. Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy? BJU Int. 108(1), 130–138 (2011).
    • 4. Smith A, Matin S, Jarrett T. Urothelial tumors of the upper urinary tract and ureter. In: Campbell–Walsh Urology, 11th Edition. Elsevier Saunders, PA, USA, 1365–1402 (2016).
    • 5. Mehrazin R, Olsson C. 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. Ghazi A, Shefler A, Gruell M, Zimmermann R, Janetschek G. A novel approach for a complete laparoscopic nephroureterectomy with bladder cuff excision. J. Endourol. 24(3), 415–419 (2010).
    • 7. Palou J, Caparrós J, Orsola A, Xavier B, Vicente J. Transurethral resection of the intramural ureter as the first step of nephroureterectomy. J. Urol. 154(1), 43–44 (1995).
    • 8. Gill IS, Soble JJ, Miller SD, Sung GT. 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. Wong C, Leveillee RJ. 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. Cormio L, Selvaggio O, Di Fino G et al. 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. Geavlete P, Multescu R, Geavlete B, Georgescu D, Moldoveanu C. Bipolar plasma vaporization – an innovative intramural ureter detachment method during nephroureterectomy. J. Med. Life. 5(2), 153–156 (2012).
    • 12. Guo G, Yang Y, Dong J, Zhenhong Z, Zhang X. 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. Nanigian DK, Smith W, Ellison LM. Robot-assisted laparoscopic nephroureterectomy. J. Endourol. 20(7), 463–465; discussion 465–466 (2006).
    • 14. Hemal AK, Stansel I, Babbar P, Patel M. Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning. Urology 78(2), 357–364 (2011).
    • 15. Tamhankar AS, Patil SR, Ahluwalia P, Gautam G. 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. Li WM, Shen JT, Li CC et al. 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. Wen J, Ji ZG, Li HZ. Treatment of upper tract urothelial carcinoma with ureteroscopy and thulium laser: a retrospective single center study. BMC Cancer 18(1), 196 (2018).
    • 18. Saika T, Nishiguchi J, Tsushima T et al. 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. Geavlete P, Georgescu D, Bancu S, Mirciulescu V. Endoscopic ureteral procedures for one-step nephroureterectomy: experience in 100 cases. J. Endourol. 21(9), 1019–1024 (2007).
    • 20. Brown JA, Strup SE, Chenven E, Bagley D, Gomella LG. Hand-assisted laparoscopic nephroureterectomy: analysis of distal ureterectomy technique, margin status, and surgical outcomes. Urology 66(6), 1192–1196 (2005).
    • 21. Romero FR, Schaeffer EM, Muntener M, Trock B, Kavoussi LR, Jarrett TW. Oncologic outcomes of extravesical stapling of distal ureter in laparoscopic nephroureterectomy. J. Endourol. 21(9), 1025–1027 (2007).
    • 22. Shalhav AL, Dunn MD, Portis AJ, Elbahnasy AM, McDougall EM, Clayman RV. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J. Urol. 163(4), 1100–1104 (2000).
    • 23. Simone G, Papalia R, Guaglianone S et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur. Urol. 56(3), 520–526 (2009).
    • 24. Ritch CR, Kearns JT, Mues AC et al. Comparison of distal ureteral management strategies during laparoscopic nephroureterectomy. J. Endourol. 25(7), 1149–1154 (2011).
    • 25. Xylinas E, Rink M, Cha EK et al. 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. Xylinas E, Kluth L, Passoni N et al. 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. Lim SK, Shin TY, Kim KH et al. Intermediate-term outcomes of robot-assisted laparoscopic nephroureterectomy in upper urinary tract urothelial carcinoma. Clin. Genitourin. Cancer 11(4), 515–521 (2013).
    • 28. Lee H, Kim HJ, Lee SE, Hong SK, Byun SS. 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. Trudeau V, Gandaglia G, Shiffmann J et al. 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. Rai BP, Shelley M, Coles B, Somani B, Nabi G. Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review. BJU Int. 110(10), 1426–1435 (2012).
    • 31. Gakis G, Schubert T, Alemozaffar M et al. 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. Nazzani S, Preisser F, Mazzone E 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. Lughezzani G, Sun M, Perrotte P et al. 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).