Resection of Ureteral Orifice During Transurethral Resection of Bladder Tumor: Functional and Oncologic Implications

Shoshany, Ohad; Baniel, Jack; Yossepowitch, Ofer

doi:10.1016/j.juro.2012.08.006

Cited by 23 publications

(25 citation statements)

References 16 publications

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“…Taken together and based in the aforementioned studies [12,16,17], the rate of postoperative vesicoureteral obstruction rate due to a TURBT close to the ureteral orifice seems to be low and thus DJ stenting to protect the ureteral orifice eventually abdicable. However, these studies include only small cohorts.…”

Section: Discussionmentioning

confidence: 94%

“…Postoperative hydronephrosis was documented in 13% of patients, with it being due to vesicoureteral obstruction in only three patients (4%). Only one patient showed UUTUC recurrence [16].…”

Section: Discussionmentioning

confidence: 94%

“…Mano et al also examined the outcome of ureteral orifice resection during TURBT (n = 84) [16]. Patients with preoperative hydronephrosis and DJ stenting during the procedure were excluded.…”

Section: Discussionmentioning

confidence: 99%

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Impact of double J stenting or nephrostomy placement during transurethral resection of bladder tumour on the incidence of metachronous upper urinary tract urothelial cancer

et al. 2020

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Background: Whether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT) harms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development remains controversial. This study evaluated the impact of DJ compared to nephrostomy placement during TURBT for bladder cancer (BCa) on the incidence of metachronous UUTUCs. Methods:We retrospectively analysed 637 patients who underwent TURBT in our department between 2008 and 2016. BCa, UUTUC and urinary drainage data (retrograde/anterograde DJ and percutaneous nephrostomy) were assessed, along with the prevalence of hydronephrosis, and mortality. Chi-square and Fisher's exact test was performed for univariate analyses. Survival analysis was performed by the Kaplan-Meier method and log-rank tests.Results: UUTUC was noted in 28 out of 637 patients (4.4%), whereas only eight (1.3%) developed it metachronously to BCa. Out of these, four patients received DJ stents, while four patients received no urinary drainage of the upper urinary tract. Placement of urinary drainage significantly correlated with UUTUC (50.0% vs. 17.9%; p = 0.041). DJ stenting significantly correlated with UUTUC (50.0% vs. 11%; p < 0.01), while no patient with a nephrostomy tube developed UUTUC. UUTUC-free survival rates were significantly lower for patients with DJ stents than for all other patients (p = 0.001). Patients with or without DJ stents had similar overall survival (OS) rates (p = 0.73), whereas patients with nephrostomy tubes had significantly lower OS rates than all other patients (p < 0.001). Conclusions: Patients with DJ stenting during TURBT for BCa might have an increased risk of developing metachronous UUTUC. This study indicated advantages in placing nephrostomy tubes rather than DJ stents; however, confirmation requires investigation of a larger cohort. Even so, the increased mortality rate in the nephrostomy group reflected hydronephrosis as an unfavourable prognostic factor.

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Section: Discussionmentioning

confidence: 94%

“…Postoperative hydronephrosis was documented in 13% of patients, with it being due to vesicoureteral obstruction in only three patients (4%). Only one patient showed UUTUC recurrence [16].…”

Section: Discussionmentioning

confidence: 94%

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Impact of double J stenting or nephrostomy placement during transurethral resection of bladder tumour on the incidence of metachronous upper urinary tract urothelial cancer

et al. 2020

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“…8 Oehlschläger and colleagues reported a case of ureteral stricture following TURBT and early adjuvant MMC instillation. 6 Although they resected the left ureteral orifice, the authors claimed that the ureteral stricture formation was associated with MMC administration regarding the length of time until diagnosis of ureteral stenosis.…”

Section: Discussionmentioning

confidence: 99%

Distal ureteral stricture: A unexpected complication of further adjuvant intravesical mitomycin C thermotherapy

Umul

Altok

Güneş

et al. 2014

CUAJ

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We present a case of distal ureteral obstruction in relation to further adjuvant intravesical thermochemotherapy with mitomycin C (MMC) for non-muscle invasive bladder cancer (NMIBC). We also discuss the diagnostic procedures and management of this recurrent case. IntroductionTransuretral resection of the bladder tumour (TURBT) is still recognized as the primary treatment option for non-muscle invasive bladder tumours (NMIBT). However, recurrence and progression are still issues despite the radical resection. The European Association of Urology (EAU) has recommendations regarding adjuvant intravesical chemotherapy in relation to risk group stratification of NMIBC.1 Mitomycin C (MMC) is one of the commonly used agents for further adjuvant intravesical treatment of intermediate and highrisk NMIBT. Moreover, adjuvant thermochemotherapy with MMC has been presented as a hopeful treatment option for further intravesical therapy in patients with high-risk tumours.2 In this report, we present a case of a ureteral orifice and distal ureter stenosis developed after adjuvant intravesical therapy as a potential side effect of MMC thermotherapy. Case reportA 65-year-old man underwent TURBT for a primary, highgrade, NMIBT (pT1G3) localized at the junction of the bladder base and left lateral bladder wall, about 2 cm away from the left ureteral orifice. The resection did not include the left ureteric orifice region and both the bladder wall and orifice were intact after resection. One early intravesical instillation of 40 mg MMC in 50 mL saline was administered postoperatively. The convalescence period was uncomplicated. A secondary resection was performed 4 weeks after the primary resection and the pathological assessment revealed inflammatory reactive changes with infiltration of eosinophils and giant cells. Ultrasonographic evaluation of the urogenital tract was normal 2 months after the primary resection. In light of the pathological evaluation of the primary tumour, we planned to administer further adjuvant intravesical immunotherapy with Bacillus Calmette-Guérin (BCG). However, the patient was unable to supply the BCG preparations. Therefore, we decided to continue further adjuvant intravesical treatment with MMC thermochemotherapy.After the decompression of the bladder, the thermotherapy was administered with the usage of the bladder wall thermochemotherapy (BWT) system (Pelvix TT system, Elmedical Ltd., Hod Hasharon, Israel) by insitillation of 40 mg MMC in 50 mg distilled water for 50 minutes with uniform 44°C temparature on the bladder wall. This induction therapy was performed weekly for 6 weeks. The patient then complained about ambiguous flank pain on the left side after 6 doses of thermochemotherapy. The ultrasonografic evaluation of the kidneys revealed a mild-to-moderate dilatation of left ureter and collecting system. Non-contrast and contrast-enhanced abdominal computed tomography scan confirmed left hydroureteronephrosis without concomitant urinary stones (Fig. 1). Transurethral resection of the obst...

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“…Um in dieser Situation eine ausreichende Resektion zu ermöglichen, kann eine schrittweise Überresektion des betroffenen Harnleiterostiums erfolgen. Trotz einer Überresektion des Ostiums kommt es selten zu einer Abflussbehinderung des oberen Harntraktes mit Entwicklung einer Hydronephrose, wie es eine Studie bei 84 Patienten nach Harnleiterostium-Überresektion auf Grund eines ostiumnahen, nichtmuskelinvasivem Blasentumor evaluierte [50]. Sie beschrieb, dass sich eine Hydronephrose bei 7 % aller Patienten entwickelte, bei denen 50 % eine spontane Remission zeigten.…”

Section: Resektion Des Harnleiterostiumsunclassified

Komplikationsmanagement bei der TUR-Blase

Mally

Paffenholz

2020

Aktuelle Urol

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ZusammenfassungDie transurethrale Resektion der Harnblase (TUR-Blase) ist ein Standardeingriff der operativen Urologie. Eine komplette Resektion steht hierbei an höchster Stelle. Darüber hinaus ist die Kenntnis der möglichen Komplikationen und das dazugehörige Komplikationsmanagement für die klinische Praxis essenziell. Zu den häufigsten Komplikationen gehören katheterassoziierte Beschwerden, Blutungen, Infektionen und die Harnblasenperforation. Doch auch die Resektion des Harnleiterostiums und Lagerungsschäden stellen zwar seltenere, aber dennoch unmittelbar behandlungswürdige Komplikationen dar. In der vorliegenden Übersichtsarbeit werden diese Komplikationen zusammengefasst sowie deren Vorbeugung und Management vorgestellt.

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Resection of Ureteral Orifice During Transurethral Resection of Bladder Tumor: Functional and Oncologic Implications

Cited by 23 publications

References 16 publications

Impact of double J stenting or nephrostomy placement during transurethral resection of bladder tumour on the incidence of metachronous upper urinary tract urothelial cancer

Impact of double J stenting or nephrostomy placement during transurethral resection of bladder tumour on the incidence of metachronous upper urinary tract urothelial cancer

Distal ureteral stricture: A unexpected complication of further adjuvant intravesical mitomycin C thermotherapy

Komplikationsmanagement bei der TUR-Blase

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