Management of lower ureter in nephroureterectomy ; analysis of the BAUS database
BAUS ePoster online library. Cleaveland P. Jun 25, 2019; 259576; P8-11
Mr. Paul Cleaveland
Mr. Paul Cleaveland
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Abstract
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INTRODUCTION

Upper urinary tract TCC is a rare disease associated by poor prognosis in high risk disease. There are no randomized trials looking at lower ureteric excision techniques despite the risk of TCC seeding if the urinary tract is entered. We evaluated UK practice through analysis of the national BAUS registry.

Method

We analysed nephroureterectomy cases in the BAUS database for 2017. There were 4 options for technique of excision of the lower ureter. We analysed these against operative time, complications, length of stay and recurrence rates.

RESULTS

1092 nephroureterectomies were recorded, with lower ureteric technique entered for 490, which were used for analysis. Median age was 72 years and 64% male. 35% stage ≥pT2 (n=172) and 45% high grade (n=222) TCC. 83% (n=405) were laparoscopic, 7% (n=34) open, 3% (n= 17) hand-assisted and 7% (n=32) robotic. Tumour site was renal pelvis 47% (n=229), upper ureter 11% (n=53) and lower ureter 24% (n=116). Lower ureter technique was endoscopic and pluck 21% (n=105), laparoscopic/robotic 36% (n=176), open extra-vesical 30% (n=146) and open intra-vesical 13% (n=63), and for lower ureteric tumours alone; 6% (n=7), 26% (n=30), 38% (n=44) and 30% (n=35) respectively. Operative time, blood loss, complications rates and length of stay were highest in open extra-vesical.

CONCLUSION

Lower ureteric excision technique varies widely, even when dealing with distal ureteric tumours, endoscopic pluck procedures were performed in 6%. This reflects the lack of evidence to indicate the procedure with best oncological control. Randomised controlled trials are required to evaluate this issue.
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