Refined Pluck Technique by Ureteral Occlusion and Transurethral Cystorrhaphy in Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial Carcinoma

Abstract

Purpose:

To evaluate the feasibility of the refined pluck technique by ureteral occlusion and transurethral cystorrhaphy in nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma (UTUC).

Materials and Methods:

Between July 2014 and March 2015, six female patients received the refined pluck technique by ureteral occlusion and transurethral cystorrhaphy in nephroureterectomy with bladder cuff excision for UTUC. Initially, the ureter orifice was occluded with intravesical silk suture transurethrally aided by extracorporeal knot tying. Transurethral excision of bladder cuff was performed by circumcision of the ureteral orifice and intramural ureter with the Collins knife. The bladder cuff is freed deeply to the extravesical space, allowing subsequent “plucking” of the entire ureter from above. The bladder defect is repaired with absorbable sutures transurethrally. The tumor was pyelocaliceal in four cases and ureteral in two cases. The follow-up was performed by cystoscopy, urine cytology, and CT scan. We present our preliminary data.

Results:

Four transperitoneal robot-assisted laparoscopic nephroureterectomy with bladder cuff excision and two hand-assisted retroperitoneoscopic nephroureterectomy with bladder cuff excision were performed. All patients are female. Histology showed high grade in everyone. There were two patients with pT1 staging, two patients with pT2 staging, and two patients with pT3 staging. There was no lymph node metastasis found in the specimen and all surgical margins were clear. No major perioperative complications occurred.

Conclusion:

This refined pluck technique by ureteral occlusion and transurethral cystorrhaphy in nephroureterectomy with bladder cuff excision for UTUC is a safe and effective alternative according to our preliminary experience. Long-term follow-up and more number of patients are needed.

No competing financial interests exist.

Runtime of video: 6 mins 34 secs