Analysis of the efficacy of treatment of bladder tumors around ureteral orifice by transurethral plasmakinetic resection combined with double J tube placement

Abstract

Objective \nTo investigate the clinical effect of transurethral plasmakinetic resection combined with double J tube placement for the treatment of bladder tumors around ureteral orifice. \n \n \nMethod \nThe clinical data of 41 cases with non-muscle invasive bladder cancer around ureteral orifice between September 2011 and May 2017 were analyzed. In the experiment group, 23 cases underwent PKRBt with double J tube placement, 18 cases in control group were treated with routine PKRBt. All patients were confirmed by CTU without ureteral expansion, hydronephrosis, and upper urinary tract tumors preoperatively. Postoperative intravesical instillation of pirarubicin chemotherapy and cystoscopy were followed up regularly. During the indwelling double J tube in the experimental group, the patients received oral alpha-blocker (Tamsulosin) and M-blocker (Solifenacin) to improve the ureteral stenting associated symptoms, and the double-J tube was removed 3 months after operation. \n \n \nResult \nAll operations were successfully accomplished without conversion to open surgery. In the experiment group, patients had significantly improved their ureteral stent-related somatic pain symptoms after combined administration of Tamsulosin and Solifenacin during indwelling double-J tubes, and no sustained intolerable urinary frequency,urgent urination, urinary incontinence and other lower urinary tract symptoms was observed. All patients had no serious adverse reactions during bladder infusion chemotherapy. After 4 to 79 months follow-up, no ureteral stenosis or hydronephrosis occurred in the experimental group. The appearance of ureteral orifice and urine spraying were normal under cystoscopy. There were 3 cases of lateral ureteral scar stenosis in the control group, two underwent ureteral bladder replantation and one underwent expansion of narrow ureter in children ureteroscope.There were 8 cases of bladder tumor recurrence in the experimental group and 7 cases in the control group. The recurrence sites were not in the original excision. After the double J tube was placed, no tumors were found in the upper urinary tract. \n \n \nConclusion \nFor non-muscle-invasive bladder tumors around the ureteral orifice, in order to reduce the incidence of ureteral orifice stenosis after PKRBt, it is routine to place double J-tubes in the ipsilateral ureter before resection. This method will not increase the risk of tumor cells retrograde implantation of upper urinary tract and affect the quality of life of patients, which is worthy of promotion and application in the clinic. \n \n \nKey words: \nBladder tumor;\xa0Double J ureter;\xa0Plasmakinetic, resection