V-03.02

Nephrouretherectomy is the gold standard procedure for the treatment of upper urinary tract tumours when conservative approach is not managed. The removal of urether at the same time of kidney is mandatory because of the high risk of local recurrence of tumour. The classical surgical technique needs two accesses: first one for the dissection of urether from the bladder wall and the second one, to isolate the kidney and upper urether to complete the nephrouretherectomy. Less invasive techniques, as endoscopic dissection of distal urether, have been proposed to reduce the morbility. Most recently, several authors suggest the combination of laparoscopic and endoscopic approach to minimize the invasivity of the treatment. However the risk of retroperitoneal spreading of neoplastic cells is considered as possible complication due to endoscopic dissection of distal urether. To avoid this complication we suggest a modified endo-laparoscopic approach previously managed by introduction of Chevassu catheter to block completely the distal segment of urether and prevent dissemination of neoplastic cells in the retroperitoneum.