Late effects of transurethral resection of bladder tumours at the ureteric orifice.

Nineteen patients, transurethrally resected for low-grade malignant tumours of the urinary bladder at or near the ureteric orifice, were investigated with respect to the presence of distal ureteric stenosis and/or vesico-ureteric reflux. The follow-up studies were performed from 6 to 28 (mean 12) months after the resection and included intravenous pyelography, voiding cystography, cytoscopy with catheterization of the ureteric orifice on the operated side, quantitative urinary culture, and serum creatinine determination. The intravenous pyelographies showed that the ureters on the operated side were significantly wider than those on the control side. This widening was recorded regardless of whether vesico-ureteric reflux was present or not. Vesico-ureteric refluxwas found on the operated side in 9 patients. No reflux was found on the control side in any patient. Preoperatively, no difference in ureteric width was observed between the tumour side and the control side. No severe stenosis was found at the follow-up investigation-in all cases at least a 5 French catheter could be inserted. Postoperatively, the urinary cultures were positive in 4 patients, 3 of whom had a vesico-ureteric reflux. A slight increase in the serum creatinine was noticed in one patient. The absence of ureteric stenosis in this series might be caused by the fact that the resection was performed with a minimum of coagulation.