Modified transurethral technique for the management of distal ureter during laparoscopic assisted nephroureterectomy

INTRODUCTION Laparoscopic assisted nephroureterectomy is a well established technique for managing the upper urinary tract urothelial cancer. However, management of the distal ureter remains a controversial issue. We describe a modified method of cystoscopic loop ligation and detachment of the distal ureter. TECHNICAL CONSIDERATION We performed transperitoneal laparoscopic assisted nephroureterectomy in 13 patients. The lower end of the ureter was managed perurethrally using our modified technique. We circumscribed the ureteric orifice with a bladder cuff using a Collins knife. We ligated the ureteric stump via cystoscope to avoid urine spillage from the upper tract. We achieved the complete excision of the distal ureter with a bladder cuff in all cases with our modified technique. CONCLUSIONS Our modified technique appears to be a simple, less invasive, and oncologically safe method to manage the distal ureter perurethrally.