Transurethral Intussusception Technique

A novel technique of managing the distal ureter and bladder cuff during an open radical nephroureterectomy was introduced by Angulo et al. (18). The "intussusception" technique was performed by placing a ureteral stone basket into the ureter of the affected side. A standard open radical nephroureterectomy is performed, and the stone basket is advanced to the proximal ureter with clips just proximal to the basket. The ureter is transected just distal to the clips, and the stone basket is advanced into the retroperitoneum and opened. The ureteral wall tissue is insinuated into the basket, which is placed on gentle traction. The ureter is then intussuscepted in its entirety into the bladder. The ureter is detached from the bladder with a transurethral resectoscope using a Collins knife (Fig. 3) (18).

The authors reported no complications in their series of 21 patients, with a mean follow-up of 44.6 months. Twenty percent of the patients had recurrence in bladder and none in the retroperitoneum (18). However, this procedure can only be used for renal pelvic tumors, as it may lead to seeding if the tumor is in the ureter. Moreover, the "stripping" of ureter may leave residual tissue behind if it is torn. Once torn, it may be difficult to retrieve it in the retroperitoneum. This occurred in 9.5% (2/21) of the patients in the authors' series. In addition, a large defect is left in the bladder, necessitating prolonged bladder drainage.

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