V08-03 Endoscopic Resection of an Enteroanastomotic Tumor Recurrence After Radical Cystectomy: A Novel Approach Using Bipolar Resection

You have accessJournal of UrologyBladder & Urothelial Upper Tract Oncology (V08)1 May 2024V08-03 ENDOSCOPIC RESECTION OF AN ENTEROANASTOMOTIC TUMOR RECURRENCE AFTER RADICAL CYSTECTOMY: A NOVEL APPROACH USING BIPOLAR RESECTION Kelly Lehner, Daniel Heslop, and Aaron Potroetzke Kelly LehnerKelly Lehner , Daniel HeslopDaniel Heslop , and Aaron PotroetzkeAaron Potroetzke View All Author Informationhttps://doi.org/10.1097/01.JU.0001009440.59296.9f.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract urothelial carcinoma (UTUC) after radical cystectomy is a relatively uncommon occurrence, with reported rates in the literature ranging from 0.8% to 6.4%. For low-grade, noninvasive disease, endoscopic tumor resection provides an effective nephron-sparing mangement approach, although the ability to effectively carry out laser ablation may be limited by tumor size. In this video, we present a novel management technique for relatively large volume UTUC recurrence in a 53-year-old male who previously underwent radical cystectomy and creation of an ileal conduit. METHODS: Our patient had a history of low grade and high grade Ta and failed multiple courses of intravesical management prior to cystectomy. At the time of cystectomy, papillary tumor was noted in the distal left ureter, and was able to be resected with negative margin prior to ureteral implantation into the conduit. Three years later, during routine surveillance, he was found to have papillary tumor recurrence in the ureters, renal pelvices, and at the site of the ureteroenteric anastamosis. Biopsy revealed low grade, noninvasive tumor. Due to bulky tumor size at the ureteroenteric anastamosis, this area proved difficult to manage with endoscopic laser ablation alone. The patient strongly desired a kidney sparing approach. RESULTS: Due to tumor size, an alternative approach was sought to achieve complete tumor resection. In this video, we demonstrate a novel technique of using a bipolar resectoscope to perform endoscopic tumor resection through an ileal conduit. Cutting loop electrocautery was used to resect a 4-cm tumor emanating from the left ureteral orifice into the ileal conduit. Total resection time was 29 minutes. There was no concern for injury to the stoma, ileal conduit, or ureteral anastamosis, confirmed with intraoperative loopogram and retrograde pyelograms. CONCLUSIONS: For bulky urothelial tumors accessible within an ileal conduit, tumor resection with a bipolar resectoscope offers a safe, feasible, and efficient method of kidney sparing UTUC management. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e557 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kelly Lehner More articles by this author Daniel Heslop More articles by this author Aaron Potroetzke More articles by this author Expand All Advertisement PDF downloadLoading ...