Laparoscopic technique
The renal stage is performed as in a radical nephrectomy, then the ureter is traced down to the bladder, the orifice with the cuff of the bladder wall is excised laparoscopically or through a mini-incision in the iliac region, the defect is sutured; the drug is removed entirely in the container. The key rule is not to open the ureter or cut it above the tumor to avoid dispersing the cells. For high-risk tumors, lymph node dissection is added. The catheter is removed after 5–7 days, and intravesical chemotherapy is administered on the first day. Recovery 3–4 weeks.
Cancer of the pelvis and ureter
Urothelial cancer of the upper urinary tract is 10 times less common than bladder cancer and is manifested by blood in the urine, lower back pain, and hydronephrosis. The standard of treatment for high-risk tumors is radical nephroureterectomy with resection of the orifice: removal of the entire ureter is mandatory, since the tumor is prone to recurrence in its stump. For small low-grade tumors and a solitary kidney, endoscopic laser treatment with follow-up is possible.
After surgery
On the first day after surgery, a chemotherapy drug is injected into the bladder once - this reduces the frequency of relapses in the bladder, which develop in 20-40% of patients. Observation includes cystoscopy every 3 months, urine cytology and MSCT. If lymph nodes are affected or there is invasion beyond the pelvis, adjuvant chemotherapy is prescribed. The remaining kidney provides function; with reduced function, treatment is agreed with a nephrologist.
