Nefroureterectomía radical laparoscópica transperitoneal con resección endoscópica de rodete vesical en tumor urotelial de tracto superior

Abstract

Introduction

Urothelial tumors are the fourth most common malignant neoplasia. Ninety to ninety-five percent are located in the bladder, and the less common upper tract urothelial carcinomas have an incidence of 2:100,000 inhabitants. Peak presentation is in patients between 70-80 years of age. Sixty percent of the tumors are invasive at the time of diagnosis and bladder recurrence in upper tract patients is 22-47%, depending on the technique employed in bladder cuff management.

Materials and methods

A 30-year-old man with no remarkable past history or risk factors sought medical attention for gross hematuria and left flank pain. A tomography scan revealed a left renal tumor suggestive of upper urinary tract urothelial tumor, which was confirmed through ureterorenoscopy with biopsy and urinary cytology. Cystoscopy showed no intravesical lesions.

Results

Transperitoneal laparoscopic nephroureterectomy with transurethral endoscopic bladder cuff excision was performed. The patient was released on the second postoperative day with no complications. The histopathology study reported transitional cell carcinoma with muscle invasion, lymph nodes negative for metastasis, and bladder cuff with no signs of tumor activity.

Discussion

Upper urinary tract urothelial tumor management has traditionally been performed as open surgery with different forms of bladder cuff excision, each with its particular advantages as well as technical difficulties. Several authors have shown the laparoscopic approach to be efficacious and safe, but the dilemma of distal ureter management has been a subject of debate.

Conclusions

When performed by the experienced surgeon, transperitoneal laparoscopic nephroureterectomy with endoscopic bladder cuff excision is a reproducible technique that has a low local recurrence rate in the management of upper tract urothelial carcinomas.