Comparative Study between Simplified Modified Ripping, Coagulation and Pluck ( RCP Technique) of Mural Part of Ureter and Open Resection of Mural Part in Radical Nephroureteroectomy

  • Mohammed Noori Al-Musawi , Ammar Sabah AL-Kaabi ‎, Ameer Aleem Jeryo
Keywords: Urothelial cancer




In radical nephroureterectomy  for high risk upper tract urothelial  cancer UTUC, mural part of                the ureter need to be removed otherwise recurrence will occur in up to 75%  .


To compare results of modified transurethral ripping, coagulation and pluck technique with                    the traditional open resection of the mural part of the ureter in the radical nephroureterectomy                 for upper TUC.


Seventeen patients with high risk upper tract urothelial cancer were managed by radical nephroureteroctomy ,7 of them the mural part was removed by open resection while for 10 patients  the mural part was managed by transurethral ripping by Collins knife then  the meatus  was closed by ball electrode coagulation before plucking of the ureter during nephroureteroctomy which was done by open method in 8  patients and by laparoscopic way  in two patients.


There is a statistically significant difference in the outcomes of endoscopic procedure (ripping, coagulation and plucking of mural ureter) in  comparison to the results of open resection for mural part of ureter ,where the  mean operative time for bladder cuff excision reduced from 75+6 to 10.5+ 2  minute ,mean total operative time reduced  from 190+2 to 100 + 7 minutes ,hospital stay from 7 + 0,6 days to 4.5 + 0.6 days, and bowel recovery  period reduced from 3.5 + 1 to 1.5 + 0.4 days     


Retrograde modified ripping-coagulation and pluck  of mural part of the ureter in radical nephroureterectomy for high risk UTUC is  rapid ,safe ,simple and applicable  with all type of radical nephroureterectomy  procedures, whether open or by minimal invasive procedures and it  applies all means  for oncological safety.