Percutaneous Ureter Occlusion with the Neodymium-YAG Laser
For intractable symptoms of bladder carcinoma patients often underwent palliative diversion. If the tumor is inoperable or the patients’s age or health preclude mayor surgery the urin is diverted without removal of the bladder. This is a better procedure and may relieve the worst symptoms. It must be emphasized that each patient presents an individual problem for which palliative diversion provides a solution in an intractable situation. The high morbidity and mortality rate must encourage the view that diversion allone has little advantage as against cystectomy on grounds of safety. Only where the latter is possible, it will usually provide better palliation and may rise life expectation. For selected patients we have to find a palliative operative procedure for an urinary diversion which prevents a slow and difficult postoperative recovery, arduous for themselves and distressing for their relatives and often creating a major nursing problem. Deep infiltrating bladder tumors often cause an unilateral ureteric obstruction with consecutive kidney damage but still normal contralateral kidney function. For these cases we propose a percutaneous nephrostomy with following occlusion of the proximal ureter by means of the neodymium-YAG laser through the nephrostoma canal.