Sellado intravesical del uréter terminal en la nefroureterectomía

objectives: to study the effectiveness and reliability of a new minimally invasive technique for the treatment of the terminal ureter in nephroureterectomy due to transitional cell carcinoma, both in open and laparoscopic procedures. methods: observational retrospective study of 14 patients that underwent intravesical sealing and endoscopic excision of terminal ureter, before ureterectomy (11 laparoscopic, 3 open), due to an upper urinary tract tumor, between july 2003 and november 2007. this procedure was performed on 11 males and 3 females, average age 59.5 years, (range: 35-70). the tumor settled on the renal pelvis in 12 cases and on the proximal ureter in 2. stage was ta - t1 in 10 patients, t2 in 3, and t3 in 1. tumor grade was g3 in 9 cases and g2 in 5. excision was carried out with a collins knife. in order to avoid contact between the urine and retroperitoneal space, the meatus was quickly sealed with a clip introduced by means of a transvesical trocar. results: total surgical time of nephroureterectomy was 231.15 minutes (range 200-340). global complication rate for the procedure was 28.4%, but the rate for the cases associated with this technique (meatus sealing and disinsertion) was 14.2%. all patients were discharged after removing bladder catheter. mean hospital stay was 10.14 days (range: 6-22). after an average follow-up of 25.3 months (range: 12-64), no retroperitoneal recurrence has been reported. one of the patients had bladder recurrence and another one developed metastasis to the suprarenal gland that was treated satisfactorily. conclusions: quick sealing of distal ureter by transvesical application of a clip before its endoscopic excision in nephrourecterectomy is a sound technique from an oncological point of view, with an acceptable complication rate that avoids a second open time to manage distal ureter.