URETER/surgery
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PURPOSE: We compared the oncologic outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery for elective treatment of clinically organ confined upper tract urothelial carcinoma of the distal ureter. MATERIALS AND METHODS: From a multi-institutional collaborative database we identified 304 patients with unifocal, clinically organ confined urothelial carcinoma of the distal ureter and bilateral functional kidneys. Rates of overall, cancer specific, local recurrence-free and intravesical recurrence-free survival according to surgery type were compared using Kaplan-Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of radical nephroureterectomy, distal ureterectomy and endoscopic surgery. RESULTS: Overall 128 (42.1%), 134 (44.1%) and 42 patients (13.8%) were treated with radical nephroureterectomy, distal ureterectomy and endoscopic surgery, respectively. Although rates of overall, cancer specific and intravesical recurrence-free survival were equivalent among the 3 surgical procedures, 5-year local recurrence-free survival was lower for endoscopic surgery (35.7%) than for nephroureterectomy (95.0%, p <0.001) or ureterectomy (85.5%, p = 0.01) with no significant difference between nephroureterectomy and distal ureterectomy. On multivariable analyses only endoscopic surgery was an independent predictor of decreased local recurrence-free survival compared to nephroureterectomy (HR 1.27, p = 0.001) or distal ureterectomy (HR 1.14, p = 0.01). Distal ureterectomy and endoscopic surgery did not significantly correlate to cancer specific or intravesical recurrence-free survival. However, when adjustment was made for ASA(®) (American Society of Anesthesiologists(®)) score, distal ureterectomy (HR 0.80, p = 0.01) and endoscopic surgery (HR 0.84, p = 0.02) were independent predictors of increased overall survival, although no significant difference was found between them. CONCLUSIONS: Because of better oncologic outcomes, distal ureterectomy could be considered the elective first line treatment of clinically organ confined urothelial carcinoma of the distal ureter.
- Klíčová slova
- carcinoma, kidney, mortality, ureter, urothelium,
- MeSH
- časové faktory MeSH
- elektivní chirurgické výkony metody MeSH
- incidence MeSH
- karcinom z přechodných buněk patologie chirurgie MeSH
- laparoskopie metody MeSH
- lidé MeSH
- lokální recidiva nádoru epidemiologie MeSH
- míra přežití trendy MeSH
- nádory močovodu patologie chirurgie MeSH
- následné studie MeSH
- nefrektomie metody MeSH
- pooperační komplikace epidemiologie MeSH
- přežití bez známek nemoci MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- ureter chirurgie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa epidemiologie MeSH
- Klíčová slova
- HYDRONEPHROSIS/surgery *, ILEUM/transplantation *, URETER/surgery *,
- MeSH
- biomedicínský výzkum * MeSH
- hydronefróza chirurgie MeSH
- ileum transplantace MeSH
- lidé MeSH
- močový měchýř * MeSH
- plastická chirurgie * MeSH
- ureter chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- INTESTINE, SMALL/transplantation *, URETER/surgery *,
- MeSH
- lidé MeSH
- střeva * MeSH
- tenké střevo transplantace MeSH
- ureter chirurgie MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- JEJUNUM *, SURGERY, OPERATIVE *, URETER *, URINARY CALCULI *,
- MeSH
- chirurgie operační * MeSH
- jejunum * MeSH
- močové kameny * MeSH
- střeva * MeSH
- ureter * MeSH
- urolitiáza * MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Radical nephroureterectomy (RNU) with the concomitant excision of the distal ureter and bladder cuff is the current standard of care for the treatment of muscle invasive and/or high-risk upper tract urothelial carcinoma (UTUC). In small uncontrolled studies, laparoscopic RNU has been suggested to be associated with better perioperative outcomes compared to open RNU. The aim of our study was to compare the perioperative oncological and functional outcomes of open RNU versus laparoscopic RNU after adjusting for preoperative baseline patient-related characteristics. METHODS: We evaluated a multi-institutional retrospective database composed by 1512 patients diagnosed with UTUC and treated with open or laparoscopic RNU between 1990 and 2016. Perioperative outcomes included operative time, blood loss, and length of hospital stay, as well as postoperative complications, readmission, reoperation, and mortality rates at 30 and 90 days from surgery. A 1:1 propensity score matching estimated using logistic regression with the teffects psmatch function of STATA 13® (caliper 0.2, no replacement; StataCorp LLC; College Station, TX, USA) was performed using preoperative parameters such as: age, gender, Body Mass Index (BMI), and American Society of Anesthesiologists (ASA) Score. RESULTS: Overall, 1007 (66.6%) patients were treated with open and 505 (33.4%) with laparoscopic RNU. Open RNU resulted into shorter median operative time (180 vs. 230 min, P<0.001) and longer median hospital stay (10 vs. 7 days, P<0.001) in comparison to laparoscopic RNU. No statistically significant difference was identified for the other variables of interest (all P>0.05). At multivariable linear regression after propensity score matching adjusted for lymph node dissection and year of surgery, laparoscopic RNU resulted in longer operative time (coefficient 43.6, 95% CI 27.9-59.3, P<0.001) and shorter hospital stay (coefficient -1.27, 95% CI -2.1 to -0.3, P=0.01) compared to open RNU, but the risk of other perioperative complications remained similar between the two treatments. CONCLUSIONS: Laparoscopic RNU is associated with shorter hospital stay, but longer operative time in comparison to open RNU. Otherwise, there were no differences in other perioperative outcomes between these surgical modalities even after propensity score matching. The choice to offer laparoscopic or open RNU in the treatment of UTUC should not be based on concerns of different safety outcomes.
Injury of the ureter is the most frequent trauma in urological practice. The most important deal concerning a patient's expectancy is early diagnosis and adequate treatment. During 1994-1998 the authors have treated 65 patients with diagnosis an injury of the ureter. The most frequent cause was the iatrogenic injury. Timing of surgery was 5-6 weeks. A percutaneous nephrostomy was the most frequent method of initial treatment (38 patients). Ureterorhaphy (32 patients), ureterocystoneostomy (12 patients) and Boari's flap operation (5 patients) was the most frequent definitive method of the treatment.
- Klíčová slova
- BLADDER *, SURGERY, OPERATIVE *, URETER *, URETERAL OBSTRUCTION *, URINARY DIVERSION *,
- MeSH
- chirurgie operační * MeSH
- diverze moči * MeSH
- lidé MeSH
- močový měchýř * MeSH
- obstrukce močovodu * MeSH
- ureter * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- INTESTINES/surgery *, URETER/surgery *,
- MeSH
- chirurgie trávicího traktu * MeSH
- střeva chirurgie MeSH
- ureter chirurgie MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- URETER/surgery *,
- MeSH
- lidé MeSH
- plastické hmoty * MeSH
- protézy a implantáty * MeSH
- ureter chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- plastické hmoty * MeSH
In 19 women (aged 27-66 years, mean 44.6 years) a retrospective analysis of the urological complications suffered during gynecological surgery was performed. 14 (73.6%) patients had ureteral injuries with concomitant bladder lesions in two. In the remaining 4 (21%) bladder injury only was present including a woman with a simultaneous urethral lesion. In the postoperative period 3 ureteric, 5 vesicovaginal, and one vesicouterine fistula developed. Intraoperative diagnosis followed by immediate surgical repair of the ureteric and bladder lesions was performed in 2 (10.5%) patients only. Except one case ureteral injury was unilateral, and predominantly right-sided (10:5). One patient suffered injury of one of the ureters in a complete ureteral duplication. The most frequent side of ureteral injury was at the level of the uterine artery with complete ligature of the ureter in 10 (71.4%), and partial in 4 (28.6%) patients. Percutaneous nephrostomy as a temporary diversion was performed in 8 (57.1%) patients. Definitive treatment involved simple Paquin ureteral reimplantation in 5 patients, Boari's procedure in 3, and psoas hitch technique once. Ureteral lysis only was sufficient in 3 patients. The surgical treatment including repair of vesical fistulas was in all cases successful.
- MeSH
- dospělí MeSH
- gynekologické chirurgické výkony škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- močové ústrojí zranění MeSH
- peroperační komplikace MeSH
- retrospektivní studie MeSH
- senioři MeSH
- ureter zranění chirurgie MeSH
- vezikovaginální píštěl etiologie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
