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Journal Information
Vol. 37. Issue 4.
Pages 249-255 (April 2013)
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Vol. 37. Issue 4.
Pages 249-255 (April 2013)
Surgical technique
Ureterectomy in the treatment of urothelial carcinoma of the distal ureter
La ureterectomía distal laparoscópica en el tratamiento del carcinoma urotelial del uréter distal
A. García-Seguia,??
Corresponding author

Corresponding author.
, I. Gómeza, A. García-Tellob, F. Cáceresb, J.C. Angulob, M. Gascóna
a Servicio de Urología, Hospital General Mateu Orfila, Mahón, Spain
b Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, Spain
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Table 1. Operative results of the published series of laparoscopic distal ureterectomy (L) and robot-assisted laparoscopic (RAL).
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Segmental ureterectomy with preservation of the kidney is a treatment option for the low grade urothelial carcinoma (LG-UC) in distal ureter that is not a candidate for endoscopic resection. Laparoscopic distal ureterectomy (LDU) with ureteral reimplantation is common in benign conditions (stenosis, iatrogenic lesion, endometriosis). However, it has been hardly described in malignant ureteral condition. The literature is reviewed in this regard and the surgical technique is described.

Material and methods

The experience regarding two cases of LDU due to low grade urothelial carcinoma in distal ureter is presented. In both, previous bladder transurethral resection (RTU) was performed. The urinary cytology was negative and the imaging studies identified urinary obstruction and distal ureter filling defect. One of the patients had a background of T1G3 bladder cancer and suffered renal failure. In both, the ureter was ligated early. Segmental ureterectomy was performed using a combined endoscopic and laparoscopic procedure with ureteral desinsertion in one case. In the other, it was exclusively laparoscopic. Both were done with 4 trocars. Ureteral reimplantation was conducted with continuous hermetic suture and without tension. In one case with background of high grade bladder tumor, pelvic lymphadenectomy was also performed.


Operating time was 180 and 240min, respectively, with estimated bleeding of 100 and 250ml. Hospitalization time was 6 and 4 days. The only post-operatory complication was paralytic ileum (Clavien I) in the first case. With a 20 and 12 month follow-up, there is no evidence of recurrence or dilatation. In the patient with renal failure, creatinine clearance improved.


The LDU with ureteral reimplantation is a complex technique. However, it represents a feasible and effective alternative for the treatment of LG-UC in distal ureter, as long as the oncological and reconstructive principles are respected.

Urothelial carcinoma
Distal ureter
Laparoscopic approach

La ureterectomía segmentaria con preservación del riñón es una opción de tratamiento para el carcinoma urotelial de bajo grado (CU-BG) en uréter distal no susceptible de resección endoscópica. La ureterectomía distal laparoscópica (UDL) con reimplantación ureteral es habitual en patología benigna (estenosis, lesión iatrogénica, endometriosis); pero se ha descrito escasamente en patología ureteral maligna. Se revisa la literatura al respecto y se describe la técnica quirúrgica.

Materal y métodos

Se expone la experiencia relativa a dos casos de UDL por carcinoma urotelial de bajo grado en uréter distal. En ambos se llevó a cabo RTU vesical previa, la citología urinaria fue negativa y los estudios de imagen identificaron obstrucción urinaria y defecto de llenado en uréter distal. Uno de los pacientes tenía antecedentes de neoplasia vesical T1G3 y padecía insuficiencia renal. En ambos el uréter se ligó precozmente. La ureterectomía segmentaria se practicó mediante procedimiento combinado endoscópico y laparoscópico con desinserción ureteral en un caso, y en el otro de forma exclusivamente laparoscópica; ambos con 4 trócares. La reimplantación ureteral se llevó a cabo con sutura continua hermética y sin tensión. En un caso con antecedente de tumor vesical de alto grado se practicó también linfadenectomía pélvica.


El tiempo operatorio fue 180 y 240min, respectivamente; el sangrado estimado 100 y 250ml; y el tiempo de ingreso 6 y 4 días. La única complicación post-operatoria fue ileo paralítico (Clavien I) en el primer caso. Con un seguimiento de 20 y 12 meses no hay evidencia de recidiva ni de dilatación. En el paciente con insuficiencia renal el aclaramiento de creatinina mejoró.


La UDL con reimplantación ureteral es una técnica compleja, pero representa una alternativa factible y efectiva para el tratamiento del CUBG en uréter distal, siempre que se respeten los principios oncológicos y reconstructivos.

Palabras clave:
Carcinoma urotelial
Uréter distal
Abordaje laparoscópico


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