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Surgical Advances in Nephroureterectomy: Laparoscopic and Robotic Approaches

  • Jonathan Bloom
  • John L. Phillips
Chapter

Abstract

Nephroureterecomy represents the gold standard in surgical treatment of upper urinary tract urothelial carcinoma (UUT-UC). UUT-UC represents a highly aggressive disease with poor survival once invasive and high recurrence rates if the distal ureter and bladder cuff remain in place. This necessitates the need for urologists to make every attempt to remove the diseased tissue. While the basic principle of the nephroureterectomy surgery have remained the same, advances in technology have allowed surgeons to develop new ways to deal with the most challenging aspect of performing this surgery, removal of the distal ureter and bladder cuff. Despite the multitude of techniques to remove the distal ureter, surgeon preference and patient specifics provide the best tools for surgical planning. Currently, minimally invasive techniques such as endoscopic resection of the ureteral orifice, laparoscopy, and robotic-assisted surgeries have been developed with the goal of reducing postoperative pain, hospitalizations, and perioperative complications while still providing excellent cancer control. Finally, new treatment modalities, such as preoperative chemotherapy, have shown promise in lower tract disease but current studies lack data from prospective trials to make it the standard of care.

Keywords

Nephroureterectomy Upper urinary tract urothelial carcinoma (UUT-UC) Distal ureter Bladder cuff Transurethral resection ureteral orifice (TUR-UO) Lymphadenectomy Recurrence Survival Neoadjuvant chemotherapy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyWestchester Medical Health Network/New York Medical CollegeValhallaUSA
  2. 2.Urologic Oncology BranchNational Institute of HealthBethesdaUSA

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