Experience of nephroureterectomy with modified "pluck" method--En bloc removal of kidney and ureter

Abstract

Transurethral removal of the ureter in nephroureterectomy has been reported by several centers as being a useful procedure. We also have employed this procedure in selective cases, but we had several problems in this procedure. So we tried the modified pluck nephroureterectomy technique (En bloc removal of kidney and ureter) to improve the procedure. Since October 1999 to September 2000, we employed this technique in 9 cases with renal pelvic or ureteral tumor, 2 with renal cell carcinoma and 3 with benign diseases. Standard nephrectomy is performed. After transurethral resection of the ureteral meatus, the distal ureter is freed by blind retroperitoneal dissection and plucked out of the bladder in continuity with the kidney. The bladder is drainaged for 6-10 days after surgery. The average time and blood loss during the operation were 247 minutes and 287 ml. No appreciable complications such as retroperitoneal urine leakage or hemorrhage during or after the procedure were observed. The modified pluck technique is useful because of its easiness and minimal invasiveness.