[Endoscopic ureterectomy]

Endoscopic ureterectomy is a minimally invasive surgical technique indicated in cases warranting ureterectomy to complement extended nephrectomy for pyelocaliceal urothelial carcinoma. The results achieved are identical to those of conventional ureterectomy (open surgery) without the inconvenience or sequelae that usually present with the latter procedure. In 1982, the authors developed the modified Dell'Adami and Breda endoscopic ureterectomy technique. To date, they have performed their modified technique in 10 cases: 9 with infiltrating urothelial or highly malignant pyelic or caliceal tumor and 1 with diffuse leukoplasia and cholesteatoma of renal pelvis. The technique described herein permits intussusception of the ureter into the bladder by transurethral traction of a Chevassu ureteral catheter to which that cephalad end of the ureter is attached during the extended nephrectomy procedure. Once intussusception of the ureter has been achieved, a resectoscope is used to cut the ureter at the level of the ureteral meatus. Thereafter the mucosa of the corresponding trigonal horn is completely resected. The results are highly satisfactory in patients whose ureter has not previously been submitted to open surgery and is not compromised by tumor spread.