N36 Laparoscopic nephroureterectomy combined with transurethral laser excision of a rosette in urinary bladder as a modern treatment method of upper urinary tract carcinomas (Preliminary report)

The aim of the study was to introduce a new treatment method of upper urinary tract carcinomas (based on the Mc Donald's concept from 1952) using holmium laser for excision of a rosette in the bladder combined with laparoscopic nephrectomy and to evaluate the treatment effectiveness in the group of 9 patients.

From January to June 2009, 9 patients with UUTT had nephroureterectory by the combined method consisting of endoscopic excision by holmium laser of a rosette in the bladder and subsequent laparoscopic removal of a kidney and ureter without urinary bladder suturing. The patients were qualified for surgery on the basis of urography, abdominal cavity CT, ascending pyelography and ureterorenoscopy. Seven men and two women at the age from 62 to 80 years were operated in general aesthesia. The mean age was 70 years. All patients had intraparietal ureter part removed with Ho YAG laser. Energy dose was 10 J and frequency 5 Hz. All patients after endoscopy had a 24 Ch catheter inserted into urinary bladder. 7 patients had laparoscopic nephroureterectomy, 2 patients because of cardiologic diseases were not qualified for laparoscopic procedure and they had nephroureterectomy by lumbar access.7 patients were operated due to renal pelvis tumour, and 2 patients due to ureter tumour. Ureter tumours were located on the right side, 4 renal pelvis tumours were localized on the left side, and 3 on the right side. Control examinations in all the patients consisted of cystography on the 10^th day after catheter removal, cystoscopy 3 months after the surgery, abdominal cavity USG 3 months after the surgery and abdominal cavity CT after 12 months. Taking samples of the bladder in the site of the scar of rosette laser removal was planned in all the patients.

The mean time of endoscopic and laparoscopic procedure was 110 minutes; endoscopy 20 min and laparoscopy 90 min. All patients had urine derivation by 24 Ch catheter and the urinary bladder was not sutured. Cystography made after catheter removal did not show any urine infiltrations. The patients average stay in hospital was 6 days. Three control cystoscopies did not detect macroscopic tumours in urinary bladder.

Endoscopy laser method of treatment of upper urinary tract tumours is a simple, patient friendly method because of decreased traumatic effect, with reduced period of reconvalescence (operation and hospitalization) and providing negative oncological effects to the same extend as the classic method.