ArticleTherapeutic advances in urology
Optimal bladder cuff management in radical nephroureterectomy: A multicenter retrospective cohort study comparing one-position excision versus ureteral pluck technique.
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Abstract
Background: Given the complexity of radical nephroureterectomy (RNU), simplifying the procedure is particularly important. Objective: To compare perioperative and oncological outcomes, this study evaluated a novel one-position bladder cuff resection (nRNU) against the conventional ureteral pluck technique (UPT) for distal ureter excision in RNU, a procedure traditionally requiring patient repositioning. Design: A multicenter retrospective cohort study comparing two approaches to bladder cuff management. Methods: This study evaluated patients with upper urinary tract urothelial carcinoma (UTUC) who underwent laparoscopic RNU between January 2015 and November 2024. Participants were stratified into two groups: a nRNU group and a UPT group. Data on baseline characteristics, perioperative outcomes, and oncological results were collected. Results: In this study, 169 patients were enrolled according to predefined inclusion and exclusion criteria, of whom 135 underwent nRNU and 34 underwent UPT. Baseline demographic and clinicopathological characteristics were well balanced between the two groups. Perioperative outcomes indicated significantly shorter operative time and reduced postoperative hospital stay in the nRNU group compared with the UPT group (operative time: 207.74 ± 50.29 min vs 256.91 ± 60.17 min, p < 0.001; postoperative hospital stay: 6 [5, 7] days vs 13.5 [12, 16] days, p < 0.001). Regarding oncological outcomes, the nRNU group exhibited a lower rate of bladder tumour recurrence than the UPT group (p = 0.006). No significant between-group difference was observed in the incidence of distant metastasis. Conclusion and Registration: Our findings suggest that the novel one-position approach to RNU is associated with an accelerated postoperative recovery process, as evidenced by reduced duration of hospitalisation and a lower incidence of subsequent bladder tumour recurrence.This study, as part of the novel one-position RNU series, have been registered with the Chinese Clinical Trial Registry (registration No. ChiCTR2400090932).
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