MODIFIED PLUCK NEPHROURETERECTOMY FOR UPPER URINARY-TRACT DISORDERS -COMBINED ENDOUROLOGICAL AND OPEN APPROACH

Nephroureterectomy is the standard surgical approach for upper urinary tract transitional-cell carcinoma (TCC) and many other conditions, In 1952, a modification of the conventional method was described in whic h a transurethral resection of the ureteral meatus and intramural mete r is undertaken until the remaining ureter has no attachment to the bl adder, The resected area and the distal tip of the ureter are coagulat ed, and the ureter is removed in continuity with the kidney through a single flank incision, Since January 1990, we have performed 12 nephro ureterectomies with this technique (9 men and 3 women with an average age of 61.8 years, ranging from 35 to 73), Six of them were operated o n for a TCC of the upper urinary tract, and the postoperative follow-u p of these patients was from 6 to 54 months (mean 18.6), Within the fo llow-up period, tumor has not recurred either at the resected trigonal area or in the retroperitoneum, and only one patient has bad a tumor distant from the site of ureteric resection, One patient with bladder TCC, who had a suspect kidney mass on the left side detected by CT, un derwent nephroureterectomy with this technique, Five patients had prim ary renal disorders and upper tract calculous problems, in which nephr oureterectomy was required, After the transurethral resection, an indw elling catheter was left in the bladder for 4 days, We believe that ou r experience confirms the feasibility of this technique in order to im prove and simplify nephroureterectomy, Therefore, we recommend the mod ified ''pluck'' technique in all patients who are candidates for an op eration requiring nephrometerectomy, as it gives considerable benefit to the patient.