Ureteral tumours

Symptoms may or may not occur. Gross hematuria (urine visible in the blood) can indicate a variety of urological issues and should always be examined closely by a urologist. A hydronephrosis caused by a tumour-related outflow obstruction can manifest itself as flank pain on the affected side.

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

If ureteral cancer is detected early, there is a good chance of recovery. The treatment is surgical.

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

The first step when a ureteral tumour is suspected is always to surgically remove tissue to confirm the diagnosis. This is done endoscopically by means of a ureterorenoscopy (URS) under general anaesthesia. Access is gained with a very long and thin instrument. This is inserted into the bladder via the urethra. There, either the right or left ureteral orifice is chosen and then the instrument is gently pushed through the ureter to the tumour or into the kidney. This is an elegant and natural way to access the tumour. Tumours can be removed in this way and “cooked” with a laser. Usually a ureteral splint is also inserted during the procedure. This thin plastic catheter ensures the unobstructed flow of urine from the kidney to the bladder after the procedure.

The tissue is examined microscopically by the pathologist and the tumour stage is determined, in order to determine the best course of treatment. Sometimes tumour removal through ureteroscopy and laser is sufficient. Regular check-ups are necessary in any case. If the tumour has already advanced but not yet spread, often the only option is the complete removal of the kidney and the affected ureter. This procedure is called a nephroureterectomy.

Inpatient admission for robot-assisted da Vinci nephroureterectomy takes place the day before the procedure. The operation takes place under general anaesthesia. The minimally invasive instruments of the robot are inserted into the abdominal cavity using the keyhole technique. Using three-dimensional vision, the surgeon can see the tumour, the entire ureter, and the kidney, and detaches them from the surrounding tissue. The robot-assisted surgical technique allows precise work with the best possible protection of the adjacent organs. The ureteral orifice to the bladder is closed via an open incision in the lower abdomen 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 about 7 days.

The tenfold magnification makes it possible to visualise the anatomical structures much better than with conventional laparoscopy. Compared to the conventional (incision) surgical technique, this results in less blood loss, less pain, and a shorter inpatient stay.

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In addition to the general risks of any surgical procedure, 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 can make dialysis necessary. However, if the remaining kidney is healthy, hardly any limitations are to be expected. There is a certain risk of recurrence depending on the stage of the tumour, making regular check-ups necessary. All possible risks of the surgical intervention are discussed prior to the procedure in a detailed explanatory discussion.

In general, professional activities corresponding to an office job are possible again 3-4 weeks after the procedure. Alternatively, follow-up treatment (AHB, Anschlussheilbehandlung) can follow the inpatient stay. Sport and physical activities can be resumed after 3 months.

The removal of the kidney and ureter is performed under general anaesthesia. Due to the small incisions made for the robot-assisted da Vinci nephroureterectomy, pain in the area of the incision in the lower abdomen is to be expected after the procedure. This can be treated with medication.