Purse-string technique for laparoscopic excision of a bladder mucosal cuff in patients with transitional cell carcinoma of the upper urinary tract: initial report with intermediate follow-up.

Abstract

To describe a novel modification for excision of a bladder mucosal cuff around the ipsilateral ureter during laparoscopic nephroureterectomy (LNU) in the patients with upper urinary tract transitional cell carcinoma (TCC). Between 2003 and 2007, 13 patients with upper urinary TCC were managed by LNU with excision of a bladder mucosal cuff. The renal pedicle was clipped early. The kidney was freed. The ureter was dissected down to the vesico-ureteric junction. The intramural part of the ureter was dissected under vision and sharply freed from the surrounding detrusor muscle of the bladder until the level of the ureteric orifice. Then the detrusor muscle was further dissected away from the underneath bladder mucosa for 1 cm around the ureteric orifice. Thus, a bladder cuff of mucosa-only could be retrieved. A purse-string suture was taken at the edge of the dissected mucosa and the cuff was excised. The intaoperative and postoperative outcome and morbidity were recorded and results of the short- and intermediate-term follow-up were evaluated. All the procedures were completed by laparoscopy. The mean operative time was 226 min. The mean blood loss was 233 mL. There were no major complications. The median follow-up was 31.5 months. During follow-up, one patient developed recurrence in the renal bed. There was no pelvic recurrences. Two patients developed papillary bladder tumours. The purse-string technique enabled complete LNU without opening of the pelvicalyceal system. Short- and intermediate-term follow-up showed the oncological safety of the procedure. The outcomes from more patients with a longer follow-up are required to confirm these preliminary findings.