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Advances in Urology
Volume 2009, Article ID 316807, 9 pages
Review Article

Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

1Department of Urology, Royal Blackburn Hospital, Blackburn, BB2 3HH, UK
2Department of Urology, University Hospital KU Leuven, Herestraat 49, 3000 Leuven, Belgium

Received 26 May 2008; Accepted 22 September 2008

Academic Editor: Norm D. Smith

Copyright © 2009 Shalom J. Srirangam et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy.