Transurethral distal ureter balloon occlusion and detachment: a simple means of managing the distal ureter during radical nephroureterectomy.

Distal ureter bladder cuff (DUBC) excision is an essential part of radical nephroureterectomy (RNU), but the technique to accomplish it remains controversial. We describe a novel technique of transurethral distal ureter balloon occlusion before detachment (TUDUBOD) whereby the affected ureter is occluded with a 5F Fogarty balloon catheter and circumferentially incised until the perivesical fat to detach it from the bladder. In the 13 patients who were treated between May 2005 and May 2010, mean surgical time for TUDUBOD was 21.3 minutes. Results for surgical margins were always negative; at mean follow-up of 39.8 months (range 16-74 mos), 4 (30.1%) patients had bladder recurrences but none occurred at the DUBC excision site or perivesical space. TUDUBOD seems to be a simple, cheap, and effective mean of managing the distal ureter during RNU that keeps with the oncologic principle of preventing tumor cell spillage outside the bladder.