Transurethral Electroresection of Tumor of Ureter Gap (Report of 65 cases)

Gu xinquan1, Zhang ming2, Zhao rui1, Fan haitao2*, Zhang gang1*, Cao xia3*

1China-Japan Union Hospital, 2The Second Hospital, 3 School of Pharmacy Jilin University

Changchun 130021, P. R. China * Corresponding author, E-mail:Caoxia@jlu.edu.cn. jlfanht@sina.com

Gu xinquan and Zhang ming contributed equally to this work

Abstract-- To discuss whether transurethral electroresection

could be used in tumors of ureter gap. 65 cases were treated

with transurethral electroresection. The operation time was

5 90 minutes and the average time was 35 minutes. The

average time in hospital was 8 days. Pathological

examination was done as a routine for all the patients. All

the patients acquired follow-up visit and time was 6 months

24 months. Urethral stricture happened in 4 cases and

they were cured by regular distension. There was no

stricture or back flow of ureter gap after intravenous

urography and cystography. 5 cases recurred in 7 13

months after the operation. Chemotherapy was used after

operation. Stricture happened in 4 cases which were cured

by dilation of urethra. There was no case of ureterostenoma

and backstreaming of ureter. Relapses happened in 5 cases

which were undergone another operation and cured.

Key Words--Tumor;Ureter gap;Electroresection

I. INTRODUCTION

Bladder cancer has the highest incidence in urinary cancer and there is high relapse rate after treatment. Tumors of ureter gap is a special type[1,2]. The character of high morbility, recurrence and progression determines the importance of early diagnosis, therapy and reasonable treatment after the operation. The traditional method for tumor of ureter is open operation or ureteroscope. Operation is the mainly therapy method for blader cancer. Resection of the sick kidney, total nephric duct and sleeve resection of bladder around ureter gap is orthodox treatment because urothelial tumor is multiple and has high recurrence. With the development of imageology and endoscope, some scholars has taken some conservative method to treat elementary and low stage tumor. There

were 65 cases of tumors of ureter gap treated in our departments from January 2000 to January 2011. Therapeutic effect was satisfied. Here is our report.

II. CLINICAL DATA AND METHOD

A. Clinical Data

There were 65 cases including 43 males and 22 females. Their ages were from 32 to 78 and the average age was 51.5. All the cases were proved to be bladder tumors of ureter gap by cystoscope. After biopsy, pathology type was transitional cell cancer, stage ,or papilla tumor. 30 cases were on the left side and 35 cases on the right side. There were no cases of both sides. Tumor was only in ureter gap in 34 cases and there was other tumor at other part of bladder. 16 cases had benigh hyperplasia of prostate(BPH) at the same time. All the patients underwent intravenous urography (IVP) and MRU. The reports of these examination proved that there was no tumor of upper urinary tract. All the cases didn`t undergo radiotherapy or chemotherapy.

B. Operation Method

The anesthesia method was continuous epidural anesthesia or combination of lumbar and epidural anesthesia. Lithotomy position was choosed and a cushion under the rump. Circon resectoscope made in USA was used. Electric cutting power was 100 120 W and electric coagulation power was 80 W. Perfusion fluid was 5% glucose. The pouring volume of bladder was controlled to be 120 ml.

If there were tumors of other part in bladder, these tumors should be resected first and then tumors of ureter gap. Ureter gap and tumor should be resected at the same time. Resection shouldn`t be too deep and part of ureter

2011 International Conference on Human Health and Biomedical EngineeringAugust 19-22, 2011, Jilin, China

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should be saved so that ther would be no backstreaming of ureter after operation. When handling was around ureter gap, electric cutting and pure cutting electric current was used. Vapourization and electric coagulation shouldn`t be used[3]. After the operation, patients with BPH underwent transurethral vapourization and resection of prostate(TVP+TURP). But before TVP, new loop should be used. F22 gasbag urethral catheter (tri-cavity) was detained. It was not necessary to put tubes in ureter. Bldder washout with normal saline for one day. Urethral catheter was removed 3 to 7 days later.

C. Chemothearpy Method and Medicine of Irrigation of Bladder after Operations

Irrigation chemotherapy of bladder began 1 week after operations. Hydroxycamptothecin was choosed, 20 mg, once 1 week for 8 times, then once 1 month for 2 years.

III. RESULTS

The operation time was 5 90 minutes and the average time was 35 minutes. There was no case of transfusion and death. Time in hospital was 5 15 days and the average time 8 days.

Pathological examination was done as a routine for all the patients,including 12 cases of papilla tumor, 43 cases of transitional cell cancer, stage and 10 cases of transitional cell cancer, stage .

All the patients acquired follow-up visit and time was 6 months 24 months. Cystoscope, intravenous urography, cystography and urine examination of castoff cells were methods choosed once 3 months in the first year after the operation and once 6 months in the second year after the operation. If there was hematuria without irrigation of bladder, patients should be rechecked at once. Urethral stricture happened in 4 cases and they were cured by regular distension. There was no stricture or back flow of ureter gap after intravenous urography and cystography. 5 cases recurred in 7 13 months after the operation. The relapse position was not in ureter gap. The relapse cases endured transurethral resection again and changed medicine of chemotherapy. There was no relapse case again till now.

IV. DISUSSION

Bladder cancer is the most common of urinary cancer in China. Superficial cancer is in 80% of new patients.

There is high relapse rate after treatment and 20% 30% will change to be infiltrating[4]. The character of high morbility, recurrence and progression determines the importance of early diagnosis, therapy and reasonable treatment after the operation. Operation is the mainly therapy method for blader cancer and irrigation chemotherapy of bladder is followed[5]. All the cases together with BPH should resect prostate at the same time. However posterior urethra is the right position that tumor recurs at[6]. Transurethral resection of bladder tumor should be done first to avoid growth of bladder cancer cells on raw surface of prostate. All the tumor tissues should be washed out with Ellik’s bladder evacuator and bladder is washed with distilled water for several times. Loops change and then we go on with operation of prostate.

After the operation, irrigation anti-cancer medicine of bladder could make high dose medicine contact directly with cancer cells and anti-cancer effect increases. The ideal irrigation medicine should have good effect and little ill effect. Patients should have good tolerance and easily finish the whole procedure of chemotherapy. Comparing with Bacillus Calmette-Guerin, mitomycin and doxorubicin, hydroxycamptothecin is the fittest[7]. Only 5 cases recurred.

Ureteroscope and radioactive ray are the mainly diagnosis methods for primary tumor of ureter[8,9]. The main therapy for it is operation. The operation realm depends on tumor grade, stage, growth style and physical status of patients. The traditional method for tumor of ureter is open operation or ureteroscope. Resection of the sick kidney, total nephric duct and sleeve resection of bladder around ureter gap is orthodox treatment because urothelial tumor is multiple and has high recurrence. With the development of imageology and endoscope, some scholars has taken some conservative method to treat elementary and low stage tumor and got favourable effect[10]. All the cases in this group endured IVP and MRU to prove that there was no tumor of upper urinary tract. Su Yuan-hua has reported 2 cases of transurethral electroresection of ureter gap and got satisfied result[11]. According to predecessor`s experience, we treated merely tumor of ureter gap with transurethral electroresection. Ureter gap and tumor should be resected at the same time. Resection shouldn`t be too deep and part of ureter should be saved so that there would be no backstreaming of ureter

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after operation. When handling was around ureter gap, electric cutting and pure cutting electric current was used. Vapourization and electric coagulation shouldn`t be used for fear that ther would be stricture of ureter. No patients needed to use ureteral catheter. There was no stricture and backstreaming of ureter after operations during follow-up visit. It proves that for merely tumor of ureter gap transurethral electroresection has good effect. Time in hospital becomes short. Pain and money for treatment of patients decreases. With the help of effective medicine during irrigation of bladder, prognosis is satisfied. It`s worth of widely spread.

V. CONCLUSION

Stricture happened in 4 cases which were cured by dilation of urethra. There was no case of ureterostenoma and backstreaming of ureter. Relapses happened in 5 cases which were undergone another operation and cured. The relapse position was not in ureter gap. The relapse cases endured transurethral resection again and changed medicine of chemotherapy. There was no relapse case again till now. Transurethral electroresection of single tumors of ureter gap has good effect and should be widely spread.

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