Laparoscopic Nephroureterectomy in the Upper Urinary Tract Urothelial Carcinoma with Transvaginal Extraction

Ahmad  Zulfan Hendri; Prahara Yuri; Andy  Zulfiqqar; Azwar  Hashfi; Indrawarman Soerohardjo

doi:10.3889/oamjms.2020.3888

Authors

Ahmad Zulfan Hendri Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,Dr. Sardjito Hospital, Jl. Kesehatan No.1 Yogyakarta, 55281, Indonesia
Prahara Yuri Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,Dr. Sardjito Hospital, Jl. Kesehatan No.1 Yogyakarta, 55281, Indonesia
Andy Zulfiqqar Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,Dr. Sardjito Hospital, Jl. Kesehatan No.1 Yogyakarta, 55281, Indonesia
Azwar Hashfi Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Jl. Kesehatan No.1 Yogyakarta, 55281, Indonesia
Indrawarman Soerohardjo Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,Dr. Sardjito Hospital, Jl. Kesehatan No.1 Yogyakarta, 55281, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.3888

Keywords:

radical nephroureterectomy, laparoscopy, transvaginal extraction, NOTES, TV-NOTES

Abstract

BACKGROUND: The upper urinary tract urothelial carcinoma (UTUC) is a rare urological malignancy. Laparoscopic nephroureterectomy (LNU) is one of the options for minimally invasive surgery for UTUC. It has similar oncological outcomes compared to open nephroureterectomy. One of the techniques developed for specimen extraction is the transvaginal route. Transvaginal specimen extraction has advantages in the reduced risk of complications, faster recovery time, and better end result.

CASE PRESENTATION: A 37-year-old woman complained of intermittent pain in her right flank for the past 2 months, with significant weight loss. No other significant symptoms occurred. Her general condition was good with a Karnofsky Performance scale index is 90. In the right periumbilical area, there was a mobile, smooth mass palpated with the size of 10 × 12 cm. There was no tenderness. The patient underwent URS and biopsy of the right ureteral mass with pathological analysis resulting in UTUC. Then, the patient underwent laparoscopic radical nephroureterectomy.

CONCLUSION: Although the surgical procedure was safe for the patient and more effective in terms of less morbidity, faster healing time, and better cosmetic appearance, transvaginal extraction of the kidney needs to be further studied, particularly relating to the little experience of this new technique.

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