scholarly journals Application of Polymer Clip to Ligate the Distal Ureter in Retroperitoneal Laparoscopic Radical Nephroureterectomy

2021 ◽  
Author(s):  
Chunyang Wang ◽  
Hongkai Yu ◽  
Yong Song ◽  
Lei Zhang ◽  
Fan Zhang ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Transurethral Resection ◽  
Upper Tract Urothelial Carcinoma ◽  
Endoscopic Technique ◽  
Radical Nephroureterectomy ◽  
Endoscopic Clip ◽  
Distal Ureter ◽  
Upper Tract ◽  
Safe Option

Abstract Purpose：Distal ureter management in radical nephroureterectomy (RNU) is challenging. Methods: This study describes a simple endoscopic clip technique with polymer clip ligation for the management of the distal ureter during retroperitoneal laparoscopic RNU. This endoscopic technique was used in 14 patients with upper tract urothelial carcinoma (UTUC). Transurethral resection of the bladder cuff was performed using a bipolar β electrode (mounted on resectoscope). Subsequently, a Super Scope (S-scope) with a 5-mm-diameter dual working channel was used with clip applier to deliver the polymer clips, which consequently ligated the ureteral stump and avoided urine spillage from the upper tract. Results: Distal ureter was managed successfully in all 14 cases using polymer clip, without any cases of urine spillage. Conclusions: Therefore, polymer clip ligation technique provides a simple and safe option for distal ureter management in retroperitoneal laparoscopic RNU.

Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

2014 ◽  
Vol 65 (1) ◽  
pp. 210-217 ◽  
Author(s):  
Evanguelos Xylinas ◽  
Michael Rink ◽  
Eugene K. Cha ◽  
Thomas Clozel ◽  
Richard K. Lee ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Oncologic Outcomes ◽  
Radical Nephroureterectomy ◽  
Distal Ureter ◽  
Upper Tract

Clinicopathological features and oncological outcomes of urothelial carcinoma involving the ureterovesical junction

2021 ◽  
Author(s):  
Takahiro Oshina ◽  
Satoru Taguchi ◽  
Jimpei Miyakawa ◽  
Yoshiyuki Akiyama ◽  
Yusuke Sato ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Treatment Strategies ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Ureterovesical Junction ◽  
Upper Tract

Abstract Background The ureterovesical junction is the boundary between the urinary bladder and upper urinary tract. Because treatment strategies for bladder cancer and upper tract urothelial carcinoma are entirely different, urothelial carcinoma involving the ureterovesical junction requires special attention. Nevertheless, studies focusing on the disease are lacking. Methods We reviewed consecutive patients with urothelial carcinoma treated via either transurethral resection of bladder tumor (n = 2791) or radical nephroureterectomy (n = 292) between 2000 and 2020 and identified those with bladder cancer involving the ureteral orifice (n = 64) and those with upper tract urothelial carcinoma involving the intramural ureter (≤2 cm) (n = 41). After excluding overlapping cases (n = 24), 80 patients with urothelial carcinoma involving the ureterovesical junction were analyzed. Results The initial symptoms or reasons for diagnosing urothelial carcinoma involving the ureterovesical junction were hematuria (n = 30), hydronephrosis (n = 21), follow-up examinations for prior urothelial carcinoma (n = 13), screening examinations (n = 7), frequent urination (n = 6) and unknown causes (n = 3). During a median follow-up period of 42 months, 18 patients died of urothelial carcinoma. The definitive surgical treatments for urothelial carcinoma involving the ureterovesical junction were transurethral resection of bladder tumor alone (n = 26), radical nephroureterectomy (n = 41) and radical cystectomy (n = 13), with different treatments having different cancer-specific survivals. Multivariate analyses identified T stage (≥T2) as an independent predictor of shorter cancer-specific survival. Conclusions Given the positional property of urothelial carcinoma involving the ureterovesical junction, the profiles of patients with the disease were highly heterogeneous. Further optimization of treatment strategies for urothelial carcinoma involving the ureterovesical junction is urgently warranted for better clinical outcomes.

Developing a nomogram for predicting intravesical recurrence after radical nephroureterectomy: a retrospective cohort study of mainland Chinese patients

2021 ◽  
Author(s):  
Shicong Lai ◽  
Xingbo Long ◽  
Pengjie Wu ◽  
Jianyong Liu ◽  
Samuel Seery ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Tract Urothelial Carcinoma ◽  
Chinese Patients ◽  
Clinicopathological Parameters ◽  
Radical Nephroureterectomy ◽  
Ki 67 ◽  
Data Set ◽  
Mainland Chinese ◽  
Upper Tract

Abstract Objective To evaluate the role of Ki-67 in predicting subsequent intravesical recurrence following radical nephroureterectomy and to develop a predictive nomogram for upper tract urothelial carcinoma patients. Methods This retrospective analysis involved 489 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision. The data set was randomly split into a training cohort of 293 patients and a validation cohort of 196 patients. Immunohistochemical analysis was used to assess the immunoreactivity of the biomarker Ki-67 in the tumor tissues. A multivariable Cox regression model was utilized to identify independent intravesical recurrence predictors after radical nephroureterectomy before constructing a nomographic model. Predictive accuracy was quantified using time-dependent receiver operating characteristic curve. Decision curve analysis was performed to evaluate the clinical benefit of models. Results With a median follow-up of 54 months, intravesical recurrence developed in 28.2% of this sample (n = 137). Tumor location, multifocality, pathological T stage, surgical approach, bladder cancer history and Ki-67 expression levels were independently associated with intravesical recurrence (all P < 0.05). The full model, which intercalated Ki-67 with traditional clinicopathological parameters, outperformed both the basic model and Xylinas’ model in terms of discriminative capacity (all P < 0.05). Decision-making analysis suggests that the more comprehensive model can also improve patients’ net benefit. Conclusions This new model, which intercalates the Ki-67 biomarker with traditional clinicopathological factors, appears to be more sensitive than nomograms previously tested across mainland Chinese populations. The findings suggest that Ki-67 could be useful for determining risk-stratified surveillance protocols following radical nephroureterectomy and in generating an individualized strategy based around intravesical recurrence predictions.

Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma

2014 ◽  
Vol 114 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Matthew Kaag ◽  
Landon Trost ◽  
R. Houston Thompson ◽  
Ricardo Favaretto ◽  
Vanessa Elliott ◽  
...  
Keyword(s):  
Renal Function ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Renal Function Decline ◽  
Upper Tract ◽  
Preoperative Predictors
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