INTRODUCTION: We describe another variant of nephroureterectomy - antegrade mini-invasive nephroureterectomy (AMNUE). METHODS: AMNUE starts with a laparoscopic nephrectomy in the flank position. The specimen is enclosed in a bag without dividing the ureter, and the patient is positioned to the lithotomy position. Then the ureterovesical junction is excised transurethrally with a Collins knife. Finally, the specimen is removed and the ureter is plucked out through a short lower abdomen incision. PATIENTS: From March 2005 to November 2008, 35 patients underwent nephroureterectomy: 7 as an open procedure, 8 as a laparoscopic nephrectomy with open ureterectomy, 8 as a complete laparoscopic nephroureterectomy, and 12 were admitted into the AMNUE group (7 men and 5 women, mean age 71 +/- 7 years, range 54-81 years). RESULTS: Tumors were found 6 times on both sides. The mean operation time was 165 +/- 32 min (105-210 min), and the mean blood loss was 150 +/- 91 ml (50-400 ml). Histology revealed 11 urothelial cancers and 1 papillary renal cell carcinoma. There was only 1 hematoma of the abdominal wall. CONCLUSION: AMNUE is a fast, safe and easily reproducible technique. It eliminates the risk of spillage of tumorous cells into the urine, which is possible in techniques where the ureter is excised with a Collins knife as the first procedure. The disadvantages of this approach are the necessary repositioning of the patient and that the long-term oncological results are currently unknown. AMNUE can be used when a complete laparoscopic nephroureterectomy is not technically feasible due to problems in the pelvis.

Department of Urology Charles University Hospital Plzen Czech Republic

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Complete laparoscopic nephroureterectomy with intravesical lockable clip