OVERVIEW

Nephroureterectomy with bladder cuff resection is indicated in cases of urothelial cancer of the upper urinary (i.e. renal pelvis and ureter). In this surgery, the kidney is removed from the side affected by the tumor, the ureter, and the portion of the bladder where the ureter is inserted.

The reasons for performing a nephroureterectomy with a bladder cuff resection are:

  • Urothelial cancer of the renal pelvis diagnosed by flexible ureteroscopy with biopsy or selective urinary cytology
  • Urothelial cancer of the proximal ureter (upper portion) diagnosed by ureteroscopy with biopsy or selective urine cytology
  • High-grade urothelial cancer of the distal ureter (lower portion) that invades the muscular layer of the ureter

Benefits of nephroureterectomy with bladder cuff resection

By completely removing the kidney and ureter with cancer and the surrounding fatty tissue, the disease is controlled, which means that many patients with only surgery will already have a remission of cancer, even in these cases, the follow-up after of surgery is very important to detect recurrences.

When performed by laparoscopy, nephroureterectomy with a bladder cuff resection is a surgery that offers rapid recovery and little postoperative pain, compared with open surgery.

Risks and complications

The possible complications that may occur when performing a nephroureterectomy with bladder cuff resection are the same that can occur in general with any surgical procedure and these are: hemorrhage, damage to nearby organs, reactions to anesthesia, etc. However, these complications occur infrequently and can be resolved mostly during the same surgery.

The risk of conversion to open surgery is low, (<5%), this may be due to difficulty in the dissection or removal of the kidney and is done to maintain patient safety.

Most people can live with only one kidney, however, sometimes the patient may require replacement therapy of renal function (peritoneal dialysis, hemodialysis, kidney transplant) temporarily or permanently, joint management with a nephrologist for this purpose is suggested.

Alternatives to nephroureterectomy with bladder cuff resection

If the urothelial tumor is small, it can be removed by laser through a ureteroscopy. When the tumor is in the distal ureter (lower portion), a portion of the ureter can be cut and reattached. This treatment modality is reserved for low-grade tumors that do not invade the ureter muscle.

Other treatment options for patients with urothelial tumor are chemotherapy and / or radiotherapy.

In patients with urothelial cancer who are very weak, it is preferable to provide palliative treatment (relief pain, hydration, etc.) since undergoing an operation they could be weakened more.

What to expect from nephroureterectomy with bladder cuff resection?

Day of surgery:

The day of the operation will arrive in the morning to the hospital in fasting

The surgery lasts approximately 3 – 5 hours, however, this time is variable.

Anesthesia for this procedure is general, so you will be unconscious during surgery.

Pain after nephroureterectomy with bladder cuff resection is moderate and can be effectively controlled with intravenous analgesics.

Food: on the day of surgery you can eat in the afternoon, there are no food restrictions, however, a balanced diet is recommended.

Physical activity: the day after surgery you can walk. It is expected to feel a bit fatigued after any surgery, this problem resolves spontaneously within a few weeks after the nephroureterectomy with bladder cuff resection.

Hospital stay: most patients operated on for a nephroureterectomy with bladder cuff resection remain hospitalized for 2 to 3 days.

Wounds: nephroureterectomy with a bladder cuff resection requires 3 small incisions in the abdomen (each 1 cm or less), the kidney and ureter are removed through a 10 cm incision in the inguinal region or in the bikini line; once they heal completely, these scars can rarely be seen.