Extra-vesical repermeabilisation of the ureter: a possible approach for extended malignant obstruction of the lower ureter

Obstruction of the lower ureter by pelvic cancer requires a palliative trea tment. Percutaneous derivation is often performed as an emergency. If obstr uction is limited to the peri-meatic area (a few mm or a cm) resection of t he ureteral orifice can be enough to catheterize the obstructed ureter. Ste nting of the ureter can be done even if the obstruction is longer, using th e extra vesical repermeabilization. Methods: A guide wire is passed via the nephrostomy, and ureteral stent is passed over the guide wire. Dye additionned with methylene blue is injected tovisualize the lower extremity of the ureter. A regular resectoscope is p laced transuretraly, and resection is conducted using X ray localisation wi th a C arm and several incidences. The tissue resected first is usualy extr avesical, in the adipous perivesical tissue. Dissection of this area can be performed bluntly with the tip of the resectoscope until the ureter is rea ched. At this time, the resectoscope is used to open the lower extremity of the ureter, localized with the C arm. It is important to open widely the u reter, so as to be sure to catheterize easily this opening with a ureteral catheter. A double J can then be passed easily. Tunnel of several cim can b e performed using this technique. Results: Seven patients with pelvic cancer with obstruction of the last cm of the pelvic ureter were included in this series. They were recurrent pros tate cancer already treated with hormono therapy, stage T3, T4. All procedu rers were performed under rachianesthesia or general anesthesia according t o general status. After this procedure normal miction were obtain in all pa tients and nephrostomies were removed. This technique is possible for exten ded pelvic obstruction. Blunt dissection with the endoscope is usualy blood less. This palliative procedure can be done in patients with poor general condition and allows for a better quality of life than nephrostomy or urina ry diversions. (C) 2001 Editions scientifiques et medicales Elsevier SAS.