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Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

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Laparoscopic renal descensus for upper tract reconstruction.

Douglas E Sutherland¹, Stephen B Williams, Thomas W Jarrett

¹Department of Urology, Multicare Health System, Tacoma, Washington, USA. swilliams22@partners.org

Journal of Endourology

|January 5, 2011

Summary

This summary is machine-generated.

Laparoscopic renal descensus offers a simple solution for upper urinary tract reconstruction. This technique provides extra ureteral length, simplifying procedures like ureteroneocystotomy, especially in challenging pelvic cases.

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Area of Science:

Urology
Minimally Invasive Surgery
Surgical Techniques

Background:

Reconstruction of the upper urinary tract often requires complex procedures to achieve adequate ureteral length.
Traditional methods like psoas hitch, Boari flap, bowel interposition, or autotransplantation can be challenging, particularly in patients with a history of pelvic surgery or radiation.

Observation:

A 76-year-old mononephric male patient presented with recurrent carcinoma in situ in the distal ureter.
The case necessitated significant ureteral reconstruction to facilitate a tension-free anastomosis.

Findings:

A laparoscopic renal descensus technique was employed to gain an additional 8 to 10 cm of ureteral length.
This approach enabled a straightforward ureteroneocystotomy, avoiding more complex reconstructive methods.
The procedure was effective in managing the distal ureteral tumor in a patient with a single kidney.

Implications:

Laparoscopic renal descensus presents a viable, less invasive alternative for upper urinary tract reconstruction.
It simplifies ureteral reconstruction, potentially reducing operative time and morbidity.
This technique is particularly advantageous in patients with a 'hostile' pelvis, where traditional reconstructive options are limited.