Management of the Distal Ureter during Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: A Review

Introduction: The standard treatment for upper urinary tract transitional cell carcinoma (UUT-TCC) is open radical nephroureterectomy with excision of a bladder cuff. We assess the successful endoscopic completion and oncological efficacy of the various minimally invasive transurethral techniques devised for the management of the intramural ureter during nephroureterectomy. Materials and Methods: A comprehensive review of the English literature until February 2009 using the PubMed database returned 42 relevant papers. Five methods of endoscopic management of the distal ureter were identified and compared to the open technique. Results: There are no randomised studies. Successful completion of the endoscopic procedure was less (91%) for the ureteric stripping technique than for the other endoscopic modalities (99.8–100%). Recurrences were highest for laparoscopic extravesical ureteric stapling in conjunction with cystoscopic detachment of the ureter, although the numbers analysed were small. For the other endoscopic modalities, bladder recurrence, positive margins and retroperitoneal recurrence (20–37, 0–4 and 1–3%, respectively) in case series were similar compared with the open method Published online: March 24, 2010 Mr. T.R.L. Griffiths Consultant Urological Surgeon Department of Urology, Leicester General Hospital Leicester LE5 4WP (UK) Tel./Fax +44 116 258 4617, E-Mail trlg1 @ le.ac.uk © 2010 S. Karger AG, Basel 0042–1138/10/0853–0249$26.00/0 Accessible online at: www.karger.com/uin Evangelos G. Gkougkousis