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JSLS : Journal of the Society of... 2011Upper tract invasive urothelial carcinoma and horseshoe kidneys are familiar to the practicing urologist but relatively rare individual entities. The complication of...
Hand-assisted laparoscopic nephroureterectomy with cystoscopic en-bloc excision of the distal ureter and bladder cuff and isthmusectomy in a horseshoe kidney for invasive urothelial carcinoma of the renal pelvis.
Upper tract invasive urothelial carcinoma and horseshoe kidneys are familiar to the practicing urologist but relatively rare individual entities. The complication of managing them when they coexist in the same patient can be challenging. Herein, we present the first reported case in which an upper tract invasive urothelial carcinoma in a horseshoe kidney was successfully managed with a combined hand-assisted laparoscopic nephroureterectomy and isthmusectomy with cystoscopic en-bloc excision of the distal ureter and bladder cuff. This highlights the fact that complex anatomy can be managed in a completely minimally invasive fashion, and sound oncologic principles can still be maintained.
Topics: Cystoscopy; Hand-Assisted Laparoscopy; Humans; Kidney; Kidney Neoplasms; Kidney Pelvis; Male; Middle Aged; Neoplasm Invasiveness; Tomography, X-Ray Computed; Urothelium
PubMed: 21985737
DOI: 10.4293/108680811X13125733357197 -
BJUI Compass May 2023Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of... (Review)
Review
BACKGROUND
Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a debate. We aimed to assess current evidence in the literature and compare outcomes between robotic-assisted (RANU) and laparoscopic nephroureterectomy (LNU).
METHODS
A systematic review of the literature was performed for studies comparing RANU and LNU for bladder cancer. Outcome measurements were recurrence rates (local and distal), positive margins, positive lymph node yield and perioperative outcomes. Meta-analysis was performed using .
RESULTS
Our results demonstrate a significantly higher mortality rate in patients undergoing laparoscopic nephroureterectomy when compared with the robotic-assisted approach for the treatment of UTUC (1.8% vs. 1.1%, = 0.008); however, these results were inconsistent on sensitivity analysis and should therefore be interpreted with caution. No significant difference was observed for other outcomes.
CONCLUSION
The ideal approach to minimally invasive radical nephroureterectomy remains undetermined. Future research, ideally prospective randomised studies, should focus on long-term outcomes, in particular recurrence, recurrence-free survival, overall survival and the correlation between surgical technique and survival.
PubMed: 37025468
DOI: 10.1002/bco2.208 -
Cancers Sep 2023The gold standard treatment for non-metastatic upper tract urothelial cancer (UTUC) is represented by radical nephroureterectomy (RNU). The choice of surgical technique... (Review)
Review
The gold standard treatment for non-metastatic upper tract urothelial cancer (UTUC) is represented by radical nephroureterectomy (RNU). The choice of surgical technique in performing UTUC surgery continues to depend on several factors, including the location and extent of the tumor, the patient's overall health, and very importantly, the surgeon's skill, experience, and preference. Although open and laparoscopic approaches are well-established treatments, evidence regarding robot-assisted radical nephroureterectomy (RANU) is growing. Aim of our study was to perform a critical review on the evidence of the last 5 years regarding surgical techniques and outcomes of minimally invasive RNU, mostly focusing on RANU. Reported oncological and function outcomes suggest that minimally invasive RNU is safe and effective, showing similar survival rates compared to the open approach.
PubMed: 37760553
DOI: 10.3390/cancers15184585 -
Robotic Surgery (Auckland) 2016Robot-assisted surgery was just a medical curiosity until the development of the da Vinci robotic system, and since then, it has become a widely accepted surgical... (Review)
Review
Robot-assisted surgery was just a medical curiosity until the development of the da Vinci robotic system, and since then, it has become a widely accepted surgical treatment for many urological conditions such as prostate carcinoma and renal cell carcinoma. With the increase in the number of urologists using the robot and the improvement in surgeon experience, the use of the robot has been expanded to include performing radical nephroureterectomy (NU) for the treatment of primary upper tract urothelial carcinoma. We performed a literature review on robot-assisted laparoscopic NU with the aim of providing a current perspective on robot-assisted laparoscopic NU for the management of upper tract urothelial carcinoma. Surgical technique, perioperative outcomes, and oncological outcomes are discussed.
PubMed: 30697554
DOI: 10.2147/RSRR.S106792 -
Translational Andrology and Urology Aug 2020Radical nephroureterectomy is the mainstay of surgical treatment for upper tract urothelial carcinoma (UTUC), a disease which comprises approximately 5% of urothelial... (Review)
Review
Radical nephroureterectomy is the mainstay of surgical treatment for upper tract urothelial carcinoma (UTUC), a disease which comprises approximately 5% of urothelial malignancies. Minimally-invasive and nephron-sparing interventions have been explored, although thus far have not shown comparable oncologic outcomes except in a relatively narrow set of patients. Due to the relative rarity of the disease, it has taken decades and multi-disciplinary efforts to sufficiently identify prognostic factors of oncologic outcomes. Despite these efforts, however, oncologic outcomes of nephroureterectomy have remained remarkably stable over the past 30 years. New techniques, such as laparoscopic and robotic surgery, have been applied to this procedure. High level evidence regarding equivalent oncologic outcomes is lacking and open surgery remains the standard of care for high-stage disease, although there is a role for laparoscopic and robotic nephroureterectomy. The importance of bladder cuff removal in improving oncologic outcomes has been broadly accepted, although there is no consensus as to the most oncologically appropriate technique. There does appear to be evidence that endoscopic techniques confer worse oncologic control. The role of lymphadenectomy remains controversial, although there is evidence that increased nodal yield could have oncologic benefit. Given disease heterogeneity and varied technical approaches to the procedure, no consensus standardized template has been identified. There is level 1 evidence for the use of intravesical chemotherapy peri-operatively and that this intervention can improve the risk of intravesical recurrence. Advances in systemic neoadjuvant and adjuvant chemotherapy have yielded promising results and are likely to become standard of care for patients without contraindications. Immunotherapy and targeted biologic agents are also likely to improve the surgical efficacy of radical nephroureterectomy as well. Ultimately, more high level evidence is needed to identify successful surgical and medical approaches to UTUC and multi-institutional collaboration is critical to this progress.
PubMed: 32944548
DOI: 10.21037/tau.2019.12.29 -
Therapeutic Advances in Urology 2023Urothelial carcinoma can arise from the urinary bladder or from the upper urinary tract. In some instances, urinary bladder cancer (UBC) and upper tract urothelial... (Review)
Review
INTRODUCTION
Urothelial carcinoma can arise from the urinary bladder or from the upper urinary tract. In some instances, urinary bladder cancer (UBC) and upper tract urothelial carcinoma (UTUC) can be concurrently diagnosed, necessitating a combined radical cystectomy (RC) with radical nephroureterectomy (RNU). A systematic review was done on the combined procedure exploring outcomes and indications, in addition to a comparative analysis between the combined procedure and cystectomy alone.
METHODS
For the systematic review, three databases (Embase, PubMed, and Cochrane) were queried, selecting only studies that included intraoperative and perioperative data. For the comparative analysis, using the NSQIP database, CPT codes for RC and RNU were used to identify two cohorts, one with RC and RNU and one with RC alone. A descriptive analysis was performed on all preoperative variables, and propensity score matching (PSM) was performed. Postoperative events were then compared between the two matched cohorts.
RESULTS
For the systematic review, 28 relevant articles were included amounting to 947 patients who underwent the combined procedure. The most common indication was synchronous multifocal disease, the most common approach was open surgery, and the most common diversion technique was using an ileal conduit. Almost 28% of patients required blood transfusion and remained in the hospital for an average of 13 days. The most common postoperative complication was prolonged paralytic ileus. For the comparative analysis, 11,759 patients were included of which 97.5% underwent RC only and 2.5% underwent the combined procedure. After PSM, the cohort that had undergone the combined procedure showed an increased risk of renal injury, increased readmission rates, and increased reoperation rates. Whereas the cohort that had undergone RC only showed an increased risk of deep venous thrombosis (DVT), sepsis, or septic shock.
CONCLUSION
A combined RC and RNU is a treatment option for concurrent UCB and UTUC that should be cautiously utilized as it is associated with high morbidity and mortality. Patient selection, discussion of the risks and benefits of the procedure, and explanation of the available treatment options remain the most important pillars in managing patients with this complex disease.
PubMed: 37188157
DOI: 10.1177/17562872231171757 -
Translational Andrology and Urology Dec 2020The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then... (Review)
Review
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
PubMed: 33457289
DOI: 10.21037/tau.2019.12.07 -
Medicine and Pharmacy Reports Oct 2020In patients with recurrent high grade or muscle-invasive bladder cancer and concomitant upper urinary tract tumors or non-functional kidney laparoscopic radical...
BACKGROUND AND AIMS
In patients with recurrent high grade or muscle-invasive bladder cancer and concomitant upper urinary tract tumors or non-functional kidney laparoscopic radical cystectomy and nephroureterectomy with lomboaortic and pelvic lymph node dissection can be performed. We present our initial experience.
METHODS
Between 2018 and 2019, 4 patients underwent laparoscopic radical cystectomy and unilateral nephroureterectomy resection with lomboaortic and pelvic lymph node dissection. The nephroureterectomy was the first part of the surgery. It was followed by radical cystectomy with lymphadenectomy. All the specimens were removed in an endobag through a midline incision.
RESULTS
The patients' demographic characteristics and perioperative outcomes were retrospectively collected and evaluated. All surgeries were completed laparoscopically. There was no need for conversion to open surgery. The mean operative time was 286,25 min with minimal blood loss (260 ml). No major complications were reported. The mean follow-up period was 8.75 months.
CONCLUSION
Laparoscopic radical cystectomy and nephroureterectomy resection with lomboaortic and pelvic lymph node dissection can be safe and feasible in selected cases as an alternative approach to the open surgery, offering good oncological and functional results.
PubMed: 33225265
DOI: 10.15386/mpr-1626 -
Annals of Transplantation Oct 2020BACKGROUND The treatment of complex tumors in non-functioning renal transplants requiring surgical extirpation is challenging. Here, we report the largest series of...
BACKGROUND The treatment of complex tumors in non-functioning renal transplants requiring surgical extirpation is challenging. Here, we report the largest series of patients who underwent transplant radical nephrectomy for renal cell carcinoma (RCC) and transplant radical nephroureterectomy for urothelial cell carcinoma (UCC) in their transplanted kidneys. MATERIAL AND METHODS From 2004 to 2018, 10 patients underwent transplant radical nephrectomy (7 patients) and nephroureterectomy (3 patients). Retrospective analyses, in terms of complications, oncological recurrence, and survival, of peri-operative and long-term outcomes, were performed. RESULTS Out of the 10 patients, 7 had RCC and 3 had UCC. No intraoperative mortality occurred. Three patients presented with Clavien-Dindo grade IIIa or greater within 30 days of surgery. Two patients died within 60 days of surgery, both due to vascular events: one due to myocardial infarction and one due to stroke. Two other patients died: one after 2.9 years, due to myocardial infarction, and the other after 6 years, due to unknown reasons. At the 7-year follow-up, there was a 60% overall survival rate. For all patients, average survival post-nephrectomy was approximately 4.5 years, including the 6 living patients and 4 deceased patients. Importantly, there was no observed cancer recurrence. CONCLUSIONS This study reports outcomes of the largest series of transplant radical nephrectomy and nephroureterectomy for malignancies of renal allografts. In the optimized setting, extirpative surgeries appear safe, with favorable long-term oncological and survival outcomes.
Topics: Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Nephrectomy; Nephroureterectomy; Retrospective Studies; Survival Analysis; Treatment Outcome; Ureteral Neoplasms
PubMed: 33093437
DOI: 10.12659/AOT.925865 -
Current Urology Dec 2021In patients with high-risk bladder cancer and concomitant upper urinary tract malignancies, simultaneous cystectomy and nephroureterectomy is the principle oncological...
BACKGROUND
In patients with high-risk bladder cancer and concomitant upper urinary tract malignancies, simultaneous cystectomy and nephroureterectomy is the principle oncological procedure of choice. Nevertheless, there are still not many reports of simultaneous robot-assisted radical cystectomy (RARC) and nephroureterectomy. Therefore, the aim of this study was to evaluate outcomes and complications of simultaneous RARC and laparoscopic nephroureterectomy in our institution.
MATERIALS AND METHODS
This case series evaluated our initial clinical results of 3 patients who underwent simultaneous laparoscopic unilateral nephroureterectomy and RARC with the da Vinci Xi system between 2019 and 2020 at our hospital. Demographic data, preoperative parameters, and postoperative parameters were retrospectively analyzed.
RESULTS
All 3 patients were men whose median age was 75 years (range 73-89 years). The median total operative time was 435 minutes (range 429-484 minutes), median estimated blood loss was 377 mL (range 125-410 mL), and median hospital stay was 26 days (range 21-36 days). In all 3 cases, each trocar was used in 7 ports. The postoperative complications were stratified according to the Clavien-Dindo Classification system, and a grade 3B complication developed in 1 patient: trocar site herniation of the small bowel.
CONCLUSIONS
We reported our initial experience of simultaneous laparoscopic nephroureterectomy and RARC. A large-scale prospective, randomized, controlled trial will be required to prove the feasibility and safety of simultaneous laparoscopic nephroureterectomy and RARC.
PubMed: 35069081
DOI: 10.1097/CU9.0000000000000043