Distal and Segmental Ureterectomy
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.
KeywordsUpper tract urothelial carcinoma Distal ureterectomy Segmental ureterectomy Nephroureterectomy Oncologic efficacy Robotic ureterectomy