Difficulties in Laparoscopic Nephroureterectomy

  • Hamdy M. Ibrahim
  • Ahmed Al-KandariEmail author
  • Robert J. Stein
  • Inderbir S. Gill


Upper urinary tract urothelial carcinoma (UUT-UC) is a relatively uncommon disease and accounts for about 5% of all urothelial tumors and 5–10% of all renal tumors, respectively [1]. UUT-UC is located more commonly in the renal pelvis than in the ureter with a ratio of 3:1 [1, 2] and occurs more frequently in men with a male-to female ratio of 3:2 for tumors in the renal pelvis and 2:1 for a ureteral location [3]. The incidence of bilateral UUT-UC ranges from 2 to 8% [1, 4]. Although development of UUT-UC after primary diagnosis of bladder cancer is a rare event, occurring in only 2–4% of patients with bladder cancer [5], the development of secondary bladder cancer after primary UUT-UC is about tenfold more frequent with a risk of 20–50% [2, 6]. Open radical nephroureterectomy (O-RNU) has been the gold standard for the treatment of UUT-UC for decades. Conventional open complete nephroureterectomy with excision of the ipsilateral orifice and a bladder cuff requires one or two long incisions associated with respective morbidity. Therefore, based on the first report of McDonald in 1952, several authors have tried to minimize the access trauma with the use of an endoscopic transurethral detachment technique of the distal ureter [4]. With the advances in laparoscopic techniques and endourologic procedures, this concept has been increasingly challenged. In 1991, Clayman first described the technique of laparoscopic nephroureterectomy, which was soon replicated by various authors worldwide [7]. Compared with open surgery, advantages of laparoscopy have been reported as shorter hospital stay, decreased postoperative pain, and earlier return to normal activities [8, 9].


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Hamdy M. Ibrahim
    • 1
  • Ahmed Al-Kandari
    • 2
    Email author
  • Robert J. Stein
    • 3
  • Inderbir S. Gill
    • 4
  1. 1.Department of UrologyFayoum UniversityFayoumEgypt
  2. 2.Department of Surgery (Urology), Faculty of MedicineKuwait UniversityJabriyahKuwait
  3. 3.Center for Laparoscopic and Robotic SurgeryGlickman Urological and Kidney Institute, Cleveland ClinicClevelandUSA
  4. 4.USC Institute of UrologyKeck School of Medicine, University of Southern CaliforniaLos AngelesUSA

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