[A novel technique for distal ureterectomy and bladder cuff excision]. / Nueva técnica para la ureterectomía distal y excisión de manguito vesical.

INTRODUCTION: We describe a novel endoscopic approach and provide a literature review for the "en bloc" dissection of the distal ureter and bladder cuff during laparoscopic radical nephroureterectomy using a transvesical single port approach under pneumovesicum. MATERIALS AND METHODS: The procedure was performed in an 80-year old male with a history of gross hematuria due to left renal pelvic TCC and no history of prior bladder TCC. Laparoscopic radical nephroureterectomy was performed and the ureter was dissected down to the bladder and clipped. A single-port device was inserted transvesically and pneumovesicum established. A full thickness incision of the bladder around the ureter was performed with progressive intravesical mobilization of the distal ureter. Subsequently, a water-tight closure of the bladder defect was achieved. The distal ureter, together with the bladder cuff, was then delivered en bloc laparoscopically with the specimen. RESULTS: The operating time (LESS radical nephroureterectomy, RPLND, and bladder cuff excision) was 6hours and 15minutes. The bladder cuff time was 45minutes. There were no intra or postoperative complications and the catheter was removed after 6 days. Histopathological analysis showed kidney-invasive papillary urothelial cancer, pT3 pN0 (0/7) G3. CONCLUSION: The distal ureter and bladder cuff techniques have not yet been standardized. Management of the bladder cuff with a single port is feasible. Additional studies are needed to identify the best approach for management of the distal ureter at the time of laparoscopic nephroureterectomy.

One step endourologic management of severely encrusted stent in solitary kidney with renal impairment. A case report.

Removing a severely encrusted stent, without an initial preventive descaling of the calcification that envelopes it, can lead to serious complications such as the breaking up of the stent, lesions and ureteral avulsion. We report a case regarding an entirely endourological treatment of an encrusted stent in a single kidney patient with renal insufficiency. The time the stent had been in place was 6 months. The patient underwent bladder lithotripsy of the distal tip of the encrusted stent, ureterolithotripsy to free the intraureteral tract of any incrustation and percutaneous nephrolithotomy to deal with the stone burden around the proximal tip. The stent, once free from fragments, was removed, via anterograde, without causing any friction in the excretory tract. The anesthesia time was 3.5 h. The postoperative period was normal without any septic complications or bleeding. We observed a slight worsening of the creatininemia which, after 3 days, could be compared with the preoperative blood levels. Ten days after the operation, renal function returned to normal. Even for patients with just one kidney and renal insufficiency the endourological management of encrusted stents does not lead to a high morbidity and is quite feasible as a one step operation.