Search

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.

Radical nephroureterctomy with excision of distal ureter and the bladder cuff has been advocated as the gold standard treatment for upper tract urothelial carcinomas. The addition of distal ureterectomy and bladder cuff excision, adds to the complexity as well as post-operative recovery. Consequently, development of novel technical approached or the necessity of performing distal ureterectomy has been the topic of discussion. This chapter will focus on some main controversies and the relevant literature available to date.

Ureteroneocystostomy (UNC) is the implantation of the ureter onto the bladder. The indications for this are: Implantation of a donor ureter during renal allotransplantation Re-implantation of the native ureter during renal autotransplantation (a treatment for complex renal artery aneurysm) Re-implantation of the native or transplant ureter due to disease of the distal ureter (such as vesicoureteral reflux in native kidneys, or ureteric stenosis in transplant kidneys)