Laparoscopic nephroureterectomy with bladder cuff resection through a lower midline abdomen incision for treatment of native renal pelvic or ureteral tumor in renal transplant recipients A feasibility investigation

Shudong ZHANG; Lulin MA; Chunlei XIAO; Yi HUANG; Xiaofei HOU; Guoliang WANG; Kangping LUO; Lei ZHAO

ABSTRACT

BACKGROUND:

Following renal transplantation, native renal pelvic or ureteral tumor occurs not only on one side, but also on both sides simultaneously or continuously.

OBJECTIVE:

To describe a new procedure in managing native renal pelvic or ureteral tumor, in which, retroperitoneal laparoscopic nephroureterectomy was first done followed by transurethral resection of ureteral orifice, and finally the kidney and the complete ureter with a bladder cuff were taken out through a midline abdomen incision, and to validate its feasibility.DESIGN, TIME AND

SETTING:

A technique modification experiment was performed at the Department of Urinary Surgery, Third Hospital, Peking University between July 2004 and March 2006.

PARTICIPANTS:

Eight patients (7 males and 1 female) with native renal pelvic or ureteral tumor who received laparoscopic nephroureterectomy with bladder cuff resection were included into this study. Of them, 4 cases had bilateral lesions. Laparoscopic nephroureterectomy with bladder cuff resection was conducted 12 times totally.

METHODS:

Retroperitoneal laparoscopic nephroureterectomy was first done in the lateral decubitus, followed by transurethral resection of the ureteral orifice with resectoscope in the lithotomy position, and finally, an incision was created in the lower midline abdomen to allow dissection of the distal ureter and bladder cuff and intact specimen extraction. Postoperatively, intravesical chemotherapy was routinely performed to prevent tumor recurrence. The patients were followed up at 3, 6, and 12 months after surgery, and once a year thereafter.MAIN OUTCOME

MEASURES:

Surgery time, blood loss volume, pathological report, tumor recurrence time, tumor-free survival time, and complications.

RESULTS:

The mean surgery time was 3.8 hours (range 2.5-7 hours). The mean hemorrhage volume was 240 mL (range 50-1 200 mL). Two cases needed blood transfusion, 600 and 1 000 mL, respectively. Transitional cell carcinoma grade Ⅲ was found in 3 cases, grade Ⅱ in 4 cases, and grade Ⅰ-Ⅱ in 4 cases. In addition, there was 1 case presenting with tumor breaking through the serous membrane of the ureter and 1 case suffering from poorly differentiated adenocarcinoma. The tumor recurred locally in one case 6 months after surgery, and the remaining cases all survived in a tumor-free state.

CONCLUSION:

After renal transplantation, laparoscopic nephroureterectomy with bladder cuff resection through a lower midline abdomen incision is feasible for treatment of native renal pelvic or ureteral tumor, with low tumor recurrence rate and satisfactory excision effects.