Ureteral tumours (ureteral cancer)

Symptoms may or may not occur. Visible blood in the urine can indicate a variety of urological problems and should always be investigated by a urologist. Hydronephrosis caused by a tumour-related drainage obstruction can manifest itself as flank pain on the affected side.

Urothelial carcinoma is a type of cancer that originates from the mucous membrane of the urinary tract and as such can also affect the ureter. Other organs lined with urothelium include the kidney and the bladder.

If ureteral cancer is detected early, there are good prospects of a cure. The treatment is surgical.

In addition to a detailed consultation and a physical examination, a urine test and an ultrasound examination are carried out. If blood is found in the urine, a cystoscopy is also performed. In addition, X-ray examinations are carried out.

The first step when a ureteral tumour is suspected is always surgical tissue sampling to confirm the diagnosis. This is done endoscopically by means of ureterorenoscopy (URS) under general anaesthesia. Access is via a very thin and long instrument. This is inserted into the bladder via the urethra. There, either the right or left ureteral orifice is located and the instrument is then advanced through the ureter to the tumour or into the kidney. In this way, access is achieved elegantly via the natural route. Tumours can thus be removed and "vaporised" with a laser. In most cases, a so-called ureteral stent is also inserted during the procedure. This thin plastic catheter ensures unobstructed urine drainage from the kidney to the bladder after the operation.

The tissue is examined microscopically by the pathologist and the tumour stage is determined. The further treatment depends on this. Sometimes tumour removal by ureteroscopy and laser is already sufficient. However, regular check-ups are then required in any case. If the tumour is already advanced but has not yet spread, unfortunately often only complete removal of the kidney and the affected ureter is an option. This procedure is called nephroureterectomy.

Patients are admitted for robot-assisted da Vinci nephroureterectomy on the day before the operation. The operation takes place under general anaesthesia. The robot's minimally invasive instruments are inserted into the abdominal cavity using keyhole surgery. Under three-dimensional vision, the surgeon carefully exposes the tumour, the entire ureter and the kidney and detaches them from the surrounding tissue. The robot-assisted surgical technique allows precise work while sparing the adjacent organs as much as possible. Via an open incision in the lower abdomen, the ureteral orifice to the bladder is closed and the kidney and ureter are removed in one piece. Postoperative care takes place in the recovery room before the patient is transferred to the normal ward. The entire inpatient stay lasts approx. 7 days.

Thanks to 10x magnification, the anatomical structures can be visualised much better than with conventional laparoscopy. Compared with conventional (open) surgical techniques, this results in less blood loss, less pain and a shorter hospital stay.

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In addition to the general risks of any operation, such as bleeding or fever, insufficient kidney function (renal insufficiency) may result, depending on the functional capacity of the remaining kidney. In the worst case, this may necessitate dialysis. However, if the remaining kidney is healthy, hardly any restrictions are to be expected in this respect. Depending on the tumour stage, there is a certain risk of recurrence, which is why regular check-ups are necessary. All possible risks of the surgical procedure are discussed in a detailed consultation before the operation.

As a rule, professional activities such as office work are possible again 3–4 weeks after the operation. Alternatively, the inpatient stay is followed by follow-up rehabilitation (AHB). Sporting activities can be resumed after 3 months.

Removal of the kidney and ureter is performed under general anaesthesia. Due to the very small incisions in robot-assisted da Vinci nephroureterectomy, at most pain in the area of the incision in the lower abdomen is to be expected after the operation, which can be treated well with medication.