534 RESECTION OF URETERAL ORIFICES DURING TRANSURETHRAL RESECTION OF BLADDER TUMORS - FUNCTIONAL AND ONCOLOGICAL IMPLICATIONS

Abstract

You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2012534 RESECTION OF URETERAL ORIFICES DURING TRANSURETHRAL RESECTION OF BLADDER TUMORS - FUNCTIONAL AND ONCOLOGICAL IMPLICATIONS Roy Mano, Ohad Shoshani, Jack Baniel, and Ofer Yossepowitch Roy ManoRoy Mano Petah Tikva, Israel More articles by this author , Ohad ShoshaniOhad Shoshani Petah Tikva, Israel More articles by this author , Jack BanielJack Baniel Petah Tikva, Israel More articles by this author , and Ofer YossepowitchOfer Yossepowitch Petah Tikva, Israel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.607AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transitional cell carcinoma (TCC) of the bladder may involve the ureteral orifice occasionally, requiring its resection. Data regarding the consequences of orifice resection are sparse and conflicting. We assessed the risk of upper urinary tract obstruction and recurrence following ureteral orifice resection during transurethral resection of a bladder tumor (TURBT). METHODS The medical records of 106 patients who underwent TURBT of 111 tumors involving the ureteral orifices between 2008-2011 were reviewed. Resection was carried out using the cutting current while avoiding unwarranted coagulation around the orifice. According to our department policy in these cases, ureteral stenting was precluded invariably. Twenty-seven patients presenting with hydronephrosis were excluded. Follow-up consisted of routine cystoscopic surveillance and upper tract imaging. Study endpoints were clinical and/or radiographic evidence of upper tract obstruction and disease relapse. RESULTS A total of 84 orifice resections were performed in 65 men (82%) and 14 women (18%) at an average age of 69 years. In 7 cases (8%) the involved orifice had been resected previously, and 2 (2%) had a previous diagnosis of upper tract carcinoma. Clinical stage was T0 in 4(5%), Ta in 35 (43%), T1 in 35 (43%) and T2 in 8(10%) patients. Intestinal metaplasia was diagnosed in 2 additional cases. Sixty-two patients (74%) with available imaging 1 month or later following resection were included in the outcome analysis. Over a median follow-up of 16 months (IQR 8-27), hydronephrosis was observed in 11 cases (18%). Median time to hydronephrosis detection was 27 days (IQR 12-135). In 5 of the 11 patients (45%) the hydronephrosis was secondary to muscle invasive disease, in 3 (27%) it resolved spontaneously, and in 3 (27%) overt stricture at the ureterovesical junction requiring endoscopic intervention was detected. One patient was diagnosed subsequently with upper tract tumor involvement. Estimated tumor recurrence rates at 1 and 3 years were 25% and 58%, respectively. Corresponding rates of disease progression were 5% and 14% respectively. CONCLUSIONS Resection of the ureteral orifice during TURBT should be considered safe, rarely leading to detrimental renal obstruction or increased risk of upper tract relapse. New onset hydronephrosis in these cases is mostly attributed to muscle invasive disease or temporary obstruction. We recommend avoiding routine ureteral stenting in these cases and highlight the importance of meticulous imaging follow-up. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e219-e220 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roy Mano Petah Tikva, Israel More articles by this author Ohad Shoshani Petah Tikva, Israel More articles by this author Jack Baniel Petah Tikva, Israel More articles by this author Ofer Yossepowitch Petah Tikva, Israel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...