Aim Wide resection of the ureteral orifice (UO) may result in scarring and stenosis of the ureterovescical junction (UVJ). We aimed to describe a technique of endoscopic spatulation of the intramural ureter in patients undergoing resection of the UO at the time of transurethral resection of bladder tumour (TURBT) and to compare the surgical and oncological outcomes of this procedure with those of patients undergoing conventional UO resection. Methods The clinical records of patients who underwent TURBT at a single Institution were retrospectively analyzed. Patients who underwent conventional UO resection or UO resection followed by endoscopic spatulation of the intramural ureter were included into the analysis. The two groups were compared in terms of intra- and post-operative outcomes. Results A total of 227 patients were included into the final comparative analyses. Of them, 104 underwent conventional UO resection and 123 UO resection followed by endoscopic spatulation of the intramural ureter. The two groups were comparable for demographic and clinical features. There were not statistically significant differences in terms of mean operative times. The incidence of transient post-operative hydronephrosis as well as of UVJ scarring and stenosis was significantly lower in patients undergoing endoscopic spatulation of the intramural ureter. The two groups were similar in terms of incidence of vesicoureteral reflux (VUR) and of upper urinary tract cancer recurrence. Conclusion Endoscopic spatulation of the intramural ureter after UO resection is a safe and quick procedure that significantly reduces the incidence of transient early post operative hydronephrosis and late UVJ stricture if compared to UO resection alone. This procedure is quick to perform, safe and does not increase the risk of VUR.
Journal of endourology / Endourological Society. 2016 May 26 [Epub ahead of print]
Massimiliano Creta, Vincenzo G Mirone, Sergio Di Meo, Roberto Buonopane, Ferdinando Fusco, Vittorio Imperatore
Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli, 18620, Napoli, Campania, Italy ; ., Universita degli Studi di Napoli Federico II, 9307, Napoli, Campania, Italy ; ., Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli, 18620, Napoli, Campania, Italy ; ., Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli, 18620, Napoli, Campania, Italy ; ., Universita degli Studi di Napoli Federico II, 9307, Napoli, Campania, Italy ; ., Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli, 18620, Napoli, Campania, Italy ; .