Laparoscopic surgery of tumors of the upper urinary tract urothelium

Abstract

Introduction: Urothelial tumors of the upper urinary tract are not common. Nephroureterectomy (NU) with resection of the bladder cuff, is the treatment of choice in non-metastatic invasive muscles. Laparascopic nephroureterectomy has shown a better transoperative outcome than open surgery, but its oncological efficacy has been discussed. Objective: To describe the laparoscopic nephroureterectomy outcomes in upper urinary tract tumors. Method: An retrospective, descriptive study was carried out. From a total amount of 89 patients treated for kidney tumors with laparoscopic surgery at the CNCMAX, from January 2006 to April 2014, 11 were chosen to undergo NUL. The lumboscopic and hand-assisted transperitoneal approach were used. Results: Average age was 69.54 years. Males prevailed and preoperative physical status ASA I (81.81%). 63.63 % consulted due to hematuria. Pelvic tumors prevailed (72.72%). The lumboscopic approach was used on 54.54% of the patients. Open distal ureterectomy was performed on every patients. Average operative time was 234.1 minutes and bleeding was 237.7 ml. The only complication was postoperative bladder bleeding. T1 and T2 (54.54%) prevailed. 90.9% of the patients had a transitional cell tumor. Survival was 90%, with an average follow-up time of 28.27 months (3-56 months). Two patients (18.18%) developed a secondary bladder tumor. Conclusions:Laparoscopic surgery of the upper tract urothelium tumor of the upper urinary tract has been feasible with satisfactory oncologic and transoperative outcomes.

Keys words: urotelial tumors, nephrouretectomy, laparoscopic surgery.