Retroperitoneoscopy-assisted nephroureterectomy for the management of upper urinary urothelial cancer

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Abstract
Traditionally, transitional cell carcinoma of the upper urinary tract needs a flank incision to remove the kidney and a lower abdominal incision to remove the ureter and bladder cuff. We report the surgical techniques and the initial clinical experience of retroperitoneoscopy-assisted nephroureterectomy for the treatment of this disease. Seven patients (6 males and 1 female; mean age 64.3 years, range 47-75 years) with the pre-operative diagnosis of upper urinary tract tumour underwent retroperitoneoscopy-assisted nephroureterectomy. The operation was performed first by retroperito-neoscopic nephrectomy, dissection of the lower third ureter and bladder cuff excision were performed with the traditional open method. The whole specimen with intact urothelium was removed through the lower abdominal incisional wound. We have successfully applied this technique for six patients with urothelial tumours. In one case, this technique had to be converted to open nephroureterectomy due to severe perirenal adhesions. Retroperitoneoscopic nephrectomy needed a mean operative time of 275 min (range 235-310), and the intraoperative blood loss was minimal. The dosage of post-operative analgesics ranged between 0 and 36 mg morphine sulphate equivalents (mean 11.6). All patients could bend their body without difficulty on the third to fifth (mean 3.7) post-operative day. The mean post-operative hospital stay was 9 d (range 6-11). There was no local recurrence or distant metastasis at the follow-up of 6 months (range 5-18). Although it needs more cases and a longer follow-up to elucidate its real clinical value, our initial experience suggests that retroperitoneoscopy-assisted nephroureterectomy is an appealing technique for the treatment of upper urinary tract tumour.