Comparative Study between Simplified Modified Ripping, Coagulation and Pluck ( RCP Technique) of Mural Part of Ureter and Open Resection of Mural Part in Radical Nephroureteroectomy


ABSTRACT:BACKGROUND: In radical nephroureterectomy for high risk upper tract urothelial cancer UTUC, mural part of the ureter need to be removed otherwise recurrence will occur in up to 75% . OBJECTIVE: To compare results of modified transurethral ripping, coagulation and pluck technique with the traditional open resection of the mural part of the ureter in the radical nephroureterectomy for upper TUC.PATIENTS AND METHODS:Seventeen patients with high risk upper tract urothelial cancer were managed by radical nephroureteroctomy ,7 of them the mural part was removed by open resection while for 10 patients the mural part was managed by transurethral ripping by Collins knife then the meatus was closed by ball electrode coagulation before plucking of the ureter during nephroureteroctomy which was done by open method in 8 patients and by laparoscopic way in two patients. RESULTS: There is a statistically significant difference in the outcomes of endoscopic procedure (ripping, coagulation and plucking of mural ureter) in comparison to the results of open resection for mural part of ureter ,where the mean operative time for bladder cuff excision reduced from 75+6 to 10.5+ 2 minute ,mean total operative time reduced from 190+2 to 100 + 7 minutes ,hospital stay from 7 + 0,6 days to 4.5 + 0.6 days, and bowel recovery period reduced from 3.5 + 1 to 1.5 + 0.4 days CONCLUSION: Retrograde modified ripping-coagulation and pluck of mural part of the ureter in radical nephroureterectomy for high risk UTUC is rapid ,safe ,simple and applicable with all type of radical nephroureterectomy procedures, whether open or by minimal invasive procedures and it applies all means for oncological safety.KEYWORDS: Urothelial cancer