A novel technique to facilitate cystoscopic en bloc excision of the distal ureter and bladder cuff during laparoscopic nephroureterectomy

SummaryAimWe describe the use of Fogarty balloon catheter, during laparoscopic nephroureterectomy for upper-tract urothelial carcinoma, to facilitate countertraction and hemostasis during cystoscopic en bloc excision of the distal ureter and bladder cuff.MethodsBetween November 2005 and January 2010, the above-mentioned technique was used in 28 patients. The diseased kidney and ureter were dissected adequately by laparoscopy. The patient was placed in the dorsal lithotomy position. A 4 French Fogarty balloon catheter was introduced into the targeted distal ureter by cystoscopy and was inflated to occlude the ureteral lumen. Under countertraction of the inflated Fogarty balloon catheter, transurethral resection with a 1-cm safety margin around the ureteral orifice by a Collins knife was performed, and the distal ureter and bladder cuff were detached en bloc from the urinary bladder.ResultsThe mean surgical time was 253 minutes (range: 170–275 minutes). The mean estimated blood loss was 120mL (range: 70–350mL). The mean hospital stay was 6.3 days (range: 3–10 days). Acute urinary retention developed in one patient, who had an enlarged prostate. The catheter was reinserted and removed 7 days later. One uremic patient treated by hemodialysis developed a symptomatic lymphocele 2 months postoperatively, which improved with temporary percutaneous drainage. At a mean follow-up of 15.4 months (range: 6–26 months), no local recurrence was noted.ConclusionsThe use of Fogarty balloon catheter for countertraction during transurethral en bloc excision of the distal ureter and bladder cuff is a useful and safe technique to achieve excellent surgical results