Full retroperitoneoscopic radical nephroureterectomy with intracorporeal, extravesical bladder cuff excision – surgical technique and early outcomes

The purpose of this study was to illustrate the technique of our full retroperitoneoscopic radical nephroureterectomy (frRNU) involving an intracorporeal, extravesical bladder cuff excision (BCE) and assess its safety and early oncological outcomes. Between June 2020 and November 2023, 27 patients underwent frRNU for upper tract urothelial carcinoma. Surgical and oncological outcomes were assessed. Two (7%) patients were converted to open distal ureterectomy due to extensive fibrosis of the iliac ureter. Lymph node dissection (LND) was performed in 85% of procedures. Median operative time and blood losses were 230 (IQR: 188, 255) minutes and 125 (IQR: 100, 150) mL, respectively. Complication rate was 33%, with only two (7%) Clavien Dindo ≥ 3 complications and two (7%) patients experienced urinary fistula. Catheter was removed after six (IQR: 5, 7) days. All patients had negative surgical margins and three (11%) were pN+, with 6.5 (IQR: 3, 14) nodes removed. At a median follow-up of 11 (IQR: 3, 25) months, four (15%) patients had bladder recurrence, while no retroperitoneal recurrence occurred. Our frRNU is feasible and safe, allowing for appropriate BCE and LND. Surgical outcomes are optimal, complication rate acceptable and short-term oncological outcomes promising.