Management of the En Bloc Distal Ureter and Bladder Cuff During Retroperitoneoscopic Radical Nephroureterectomy

Abstract

Radical nephroureterectomy with resection of the en bloc distal ureter and bladder cuff is the gold standard treatment option for most patients with upper urinary tract transitional cell carcinoma (TCC). Recurrence at the distal ureter and/or peiureteral bladder mucosa in the presence of ipsilateral upper urinary tract urothelial carcinoma has clinical significance. This procedure involves radical nephrectomy and en bloc distal ureterectomy with 2- to 3-cm-diameter bladder cuff, with special care to prevent urine spillage. We describe here our pure laparoscopic technique using two suprapubic transvesical ports, with cystoscopic secured detachment and ligation of the en bloc bladder cuff and juxtavesical ureter. This laparoscopic technique duplicates established principles of open radical nephroureterectomy.