RETROPERITONEOSCOPY-ASSISTED NEPHROURETERECTOMY FOR THE MANAGEMENT OFUPPER URINARY UROTHELIAL CANCER

Traditionally, transitional cell carcinoma of the upper urinary tract needs a flank incision to remove the kidney and a lower abdominal inci sion to remove the ureter and bladder cuff. We report the surgical tec hniques acid the initial clinical experience of retroperitoneoscopy-as sisted nephroureterectomy for the treatment of this disease. Seven pat ients (6 males and 1 female; mean age 64.3 years, range 47-75 years) w ith the pre-operative diagnosis of upper urinary tract tumour underwen t retroperitoneoscopy-assisted nephroureterectomy. The operation was p erformed first by retroperitoneoscopic nephrectomy, dissection of the lower third ureter and bladder cuff excision were performed with the t raditional open method. The whole specimen with intact urothelium was removed through the lower abdominal incisional wound. We have successf ully applied this technique for six patients with urothelial tumours. In one case, this technique had to be converted to open nephroureterec tomy due to severe perirenal adhesions. Retroperitoneoscopic nephrecto my needed a mean operative time of 275 min (range 235-310), and the in traoperative blood loss was minimal. The dosage of post-operative anal gesics ranged between 6 and 36 mg morphine sulphate equivalents (mean 11.6). All patients could bend their body without difficulty on the th ird to fifth (mean 3.7) post-operative day. The mean post-operative ho spital stay was 9 d (range 6-11). There was no focal recurrence or dis tant 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 clinica l value, our initial experience suggests that retroperitoneoscopy-assi sted nephroureterectomy is an appealing technique for the treatment of upper urinary tract tumour.