Method and outcome of transvesical ureterectomy of the distal ureter in nephroureterectomy of native kidney upper tract urothelial carcinoma ipsilateral to a transplanted kidney.

OBJECTIVES: To analyze outcomes of cases in which we adapted a transvesical ureterectomy technique to remove the distal ureter, including complete removal of the bladder cuff, upon retroperitoneal nephroureterectomy (performed when the diseased native kidney and ureter are ipsilateral to the transplant kidney).

METHODS: Nineteen cases of upper urinary tract urothelial carcinoma of the native kidney were diagnosed among the 520 kidney transplant recipients at our kidney transplantation clinic over the last 19 years. Of these 19 patients, 11 had urothelial carcinoma of the native kidney ipsilateral to the transplant kidney. Excluding 2 patients in whom different surgical methods were used, we report 9 patients with nephrectomy and kidney removal through a flank incision retroperitoneally, followed by distal ureteral ureterectomy transvesically through a cystotomy incision.

RESULTS: No postoperative surgical complications were encountered among these 9 immunosuppressed kidney transplant recipients. No perioperative deterioration of transplant kidney function was found. One patient with lower ureteral T2/Tis urothelial carcinoma had a minor ureteral wall tear upon pulling-through of the ureteral hiatus, which was clamped immediately. No retroperitoneum or wound metastasis was found during follow-up, which ranged from 3 months to 11 years and 8 months.

CONCLUSIONS: This transvesical ureterectomy technique of the distal ureter upon retroperitoneal nephroureterectomy ipsilateral to the transplant kidney is an easy and expeditious approach if the urothelial carcinoma is located in the upper or midureter or renal pelvis.