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Distal and Segmental Ureterectomy

  • Ahmed A. Aboumohamed
  • Reza Ghavamian
Chapter

Abstract

Isolated ureteral urothelial carcinoma represents about 30% of upper tract urothelial carcinoma (Abouassaly et al. Urology, 76:895, 2010). Radical nephrourerectomy with en-block removal with the entire ureter along with a bladder cuff is the standard surgical management for upper tract urothelial carcinoma. Kidney-sparing techniques for management of ureteral urothelial carcinoma include endoscopic ablation/resection, percutaneous techniques, and distal/segmental ureterectomy (DU/SU). The focus of this chapter would be on DU/SU. In select scenarios, the option of DU/SU may be offered to patients with isolated ureteral urothelial carcinoma. In most cases, the consideration of DU/SU is based on patient factors as solitary kidney or the presence of renal functional impairment; however, there have to be strict tumor-related criteria that would allow the utilization of such a nephron-sparing surgical option such as low grade tumor, and single or locally confined tumors. While maximizing renal functional outcomes with DU/SU, this comes at the expense of more extensive follow-up surveillance, which may add to the complexity of follow-up of those patients and the total cost for the management of this uncommon urologic malignancy. We aim in this chapter of the book to describe indications for utilization of DU/SU, approaches and techniques that can be utilized for distal/segmental ureterectomy and urinary reconstruction, along with brief review of the current status of its use and oncologic efficacy in comparison to the gold standard nephroureterectomy.

Keywords

Upper tract urothelial carcinoma Distal ureterectomy Segmental ureterectomy Nephroureterectomy Oncologic efficacy Robotic ureterectomy 

References

  1. 1.
    Cheng YT, Flechner SM, Chiang PH. The role of laparoscopy-assisted renal autotransplantation in the treatment of primary ureteral tumor. Ann Surg Oncol. 2014;21:3691.CrossRefPubMedGoogle Scholar
  2. 2.
    Jeldres C, Lughezzani G, Sun M, et al. Segmental ureterectomy can safely be performed in patients with transitional cell carcinoma of the ureter. J Urol. 2010;183:1324.CrossRefPubMedGoogle Scholar
  3. 3.
    Colin P, Ouzzane A, Pignot G, et al. Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: results from a large French multicentre study. BJU Int. 2012;110:1134.CrossRefPubMedGoogle Scholar
  4. 4.
    Bagrodia A, Kuehhas FE, Gayed BA, et al. Comparative analysis of oncologic outcomes of partial ureterectomy vs radical nephroureterectomy in upper tract urothelial carcinoma. Urology. 2013;81:972.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Dalpiaz O, Ehrlich G, Quehenberger F et al. Distal ureterectomy is a safe surgical option in patients with urothelial carcinoma of the distal ureter. Urol Oncol. 2014;32:34 e1.CrossRefGoogle Scholar
  6. 6.
    Pedrosa JA, Masterson TA, Rice KR, et al. Oncologic outcomes and prognostic impact of urothelial recurrences in patients undergoing segmental and total ureterectomy for upper tract urothelial carcinoma. Can Urol Assoc J. 2015;9:E187.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Abouassaly R, Alibhai SM, Shah N, et al. Troubling outcomes from population-level analysis of surgery for upper tract urothelial carcinoma. Urology. 2010;76:895.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Urology DepartmentMontefiore Medical CenterBronxUSA
  2. 2.Department of Urology, Northwell HealthNorthwell Hofstra School of MedicineHempstedUSA

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