TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: A standard treatment for UC-UUT is/was open nephroureterectomy (NUE). Modern endourology gives many options to replace this approach. We assess a role of endourology in this topic.
Methods: We treat at our institution all patients with UC UUT from region with 571 thousand of inhabitants. Between 1/ 2007 and 4/2014, 147 surgeries were performed for UC-UUT.
Results: Organ sparing surgeries were accomplished in 15.0%/22 cases. In this subgroup: 19/86.4% ureteroscopic ablation (14 with Ho:YAG laser with semirigid of flexible ureteroscope and 5 operating ureteroscope with resection loop; in 2/9.1% open resection of ureter and in 1/4.5% percutaneous resection of pelvis tumour with resectoscope. NUE was indicated in 85.0% (125 cases). In 86 of them (58.5%) was used laparoscopy (55/64.0% complete laparoscopic NUE (CLNUE), 31/ 36.0% laparoscopic nephrectomy with open ureterectomy). In CLNUE, in the last 37 cases, technique of endoscopic excision of ureteral orifice with Collin’s knife and application of Hem-olok® ML clips followed with CLNUE was used. Formerly was employed technique of really CLNUE with excision of ureterovesical junction laparoscopically with Ligasure® Atlas (abandoned due to incomplete resection of intramural ureter in some cases). In rest 39 of 147 surgeries (26.5%), open NUE was carried (mainly for locally advanced tumour or N+ tumours).
Conclusions: Endourology plays crucial role in treatment of UC-UUT. In nephron sparing methods (taking 15%), ureteroscopic Ho:YAG ablation dominates. In NUE, the most frequent method is CLNUE with clip. Open surgery is applied only in open ureterectomy in distal ureter tumour or in nephrectomy phase in advanced tumours.
Source of Funding: MH CZ - DRO (Faculty Hospital in Pilsen - FNPl, 00669806), the Charles University Research Fund (project number P36), grant IGA NT 12010-5.
| Listen to an interview with Tomas Urge, one of the authors of this study. |
Presented by Milan Hora,1, 2 Petr Stransky,1 Tomas Urge,1, 2 Kristyna Kalusova,1 Olga Dolejsova,1, 2 Ondrej Hes,1, 2, and Ivan Travnıcek1, 2 at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
1Faculty Hospital Plzen, Czech Republic 2Faculty of Medicine Plzen, Charles University Prague, Czech Republic
