[Management of the bladder cuff removal by open excision versus transurethral resection of the ureteral orifice after laparoscopic radical nephroureterectomy in upper urinary tract--urothelial carcinoma]

Objectives: To assess treatment-related complication outcomes in the management of the bladder cuff removal by open excision (OE) or transurethral resection of the ureteral orifice (TURUO) after laparoscopic radical nephroureterectomy (LNU) in upper urinary tract urothelial carcinoma (UUT-UC).

Patients and methods: We did a retrospective study involving patients having UUT-UC who underwent LNU from 2004 to 2012 in two references center. Flexible ureteroscopy was carried out for multiple biopsies. Patients were assigned to one of two different surgical groups consisting of LNU with OE versus TURUO for the bladder cuff removal. Perioperative characteristics, complication related treatment and oncological outcomes were collected during the follow-up.

Results: Overall, 29 patients underwent LNU over-time including 16 using LNU with OE and 13 LNU with TURUO. LNU+OE were older (66.5 years [48-87] [P<0.01]). Operative time was shorter (180 min vs. 240 min [P=0.01]) with a longer hospital stay (7 days vs. 5 days [P<0.01]) than TURUO technic. No difference in the complication rate was reported. LNU +OE was associated with higher grade (81.3% vs. 38.5% [P=0.026]) and more invasive tumor (37.5% vs. 24.1% [P=0.03]). Regardless the technic, the cancer-specific survival rate was 63.7 years without significant differences between technics.

Conclusion: TURUO was shorter in hospital stay but had a longer operative time with no impact on the treatment-related complication. Oncological control not highlighted any difference between technics however longer follow up is expected for recommendations.