Review Article Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy. Copyright © 2009 Shalom J. Srirangam et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Primary urothelial carcinoma of the upper urinary tract accounts for about 5 % of all renal and urothelial malignancies. Though relatively uncommon, the incidence of upper tract transitional cell carcinoma (TCC) appears to be slowly increasing [1–3]. While alternative therapies, such