The endoscopic approach to the distal ureter in nephroureterectomy for upper urinary tract tumor

We reviewed the current status of the endoscopic distal ureteral approach to nephroureterectomy for transitional upper urinary tract cancer.

We reviewed the English, French and Spanish literature using a PubMed and MEDLINE search, and compared the stripping and pluck techniques. Statistical analysis was done using Fisher's exact test. Individual case reports are discussed but they were not included in the statistical analysis.

The mean rate of bladder carcinoma recurrence after ureteral resection and detachment is 19.3% for the stripping and 24% for the pluck technique. This difference is not statistically significant. In 3.1% of cases invasive bladder cancer has been noted but only after distal ureteral resection using the pluck technique.

The endoscopic approach to the distal ureter during nephroureterectomy is feasible. Bladder cancer recurrence was similar after each technique. However, isolated case reports illustrate the need for cautious selection of surgical candidates.