Novel technique for retroperitoneoscopic nephroureterectomy for patients with huge hydronephrosis

Introduction: Retroperitoneal laparoscopic nephroureterectomy (RLNU) presents a therapeutic dilemma for the surgeon, especially in the case of upper urinary tract urothelial carcinoma (UUT-UC) with huge hydronephrosis (HH). The present study describes a specific technical modification for efficient and successful RLNU for UUT-UC with HH by using the SAND balloon catheter. Patient and Methods: A 72-year-old female underwent RLNU. The SAND balloon catheter was directly inserted into the expanded hydronephrotic kidney, and the liquid was extracted appropriately. Urine leakage from the hydronephrotic kidney was avoided, because the puncture site was sealed firmly between the two adjacent balloons at the tip of the catheter. Disposal counter traction using the catheter facilitated the mobilization of the hydronephrotic kidney. Results: RLNU with HH was completed without the need for open conversion by the use of the SAND ('SAND' derived from 'sandwich') balloon catheter. Virtually no spillage occurred during the procedure. The original HH sac could be extracted at its smallest possible size. Conclusion: This method improves the surgeon's vision and facilitates the performance of a resection, without causing any spillage of the hydronephrotic kidney contents during RLNU.