Presented by: Ben Sionov MD
Department of Urology, The E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel

Introduction

Radical nephroureterectomy (RNU) with bladder cuff excision (BCE) is widely regarded as the most effective surgical intervention for managing upper urinary tract urothelial carcinoma (UTUC). However, to mitigate the potential complications associated with BCE, such as urine leakage, scarring, reduced bladder capacity, and suture line dehiscence, we have developed an approach for distal ureterectomy during RNU, involves the excision of the intramural portion of the ureter, without opening the urinary tract, eliminating the need for bladder cuff removal.

Materials

To evaluate the oncological safety of RNU with BCE compared to RNU without BCE with a focus on local and distant disease recurrence.

Results

,

Between 2008 and 2021, 107 patients with primary UTUC underwent RNU. Fifty-three patients with a follow-up of at least 12 months were included in the study. The database of the patients with and without BCE was reviewed. Demographic data, medical background, tumor characteristics, histopathology, cystoscopic and imaging results were recorded. Bladder tumor recurrence incidence and occurrence of distant metastatic disease were compared in the 2 groups.

Conclusion

Of the patient's cohort, 23 underwent RNU with BCE (group A), and 30 underwent RNU without BCE (group B). There was no statistical difference in demographics and pathologic characteristics between the groups. At a median follow-up of 39 and 28 months in groups A and B, respectively, intra-vesical disease recurrence was detected in 56% in group A versus 43% in group B, (p=0.21). Median time to first recurrence was 16 and 18 months in group A and B, respectively. Metastatic disease was diagnosed in 13.4% and 16.7% of groups A and B, respectively (p=0.71).

Funding

Laparoscopic RNU with dissection and detachment of the intramural ureter, while avoiding BCE, offers comparable oncologic outcomes to the more complex procedure involving BCE. This approach not only minimizes the risk of potential complications associated with BCE but also eliminates the need for transurethral/intraureteral instrumentation and patient repositioning.

Lead Authors

Jeffry Mattar, MD
Department of Urology, The E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel

Abraham Ami Sidi, MD
Department of Urology, The E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel

Alexander Tsivian, MD
Department of Urology, The E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Israel