Radical nephroureterectomy, including en bloc excision of the ureter with a
bladder cuff, is the standard treatment for upper tract transitional-cell
carcinoma (TCC), This procedure requires either a flank and lower abdominal
incision or an extended flank incision, Laparoscopic surgery for TCC has b
een used at several medical centers; the most challenging and controversial
aspect is the oncologically correct management of the distal ureter, We be
lieve that the Cleveland Clinic technique of securing the distal bladder cu
ff intravesically while simultaneously occluding the distal ureter prevents
tumor spillage and allows accurate and complete resection of the targeted
ureter in a manner mirroring the open procedure.