EL on TCC resectable and non in borderline TCC case near ureter

Hello Doc, the resection is the surgeon’s call depending on abilities. My query into boarded surgeons is that most surgeons like to have at least 1cm of clean tissue between the thickening to resect and the right ureteral papilla. This is pushing that border a but. The ideal scenario would be to scope first and ensure the urethra is absolutely clean, even though seems so on ultrasound but I have seen scope see small amounts of tumor in the urethra that US can’t see. and she could be laser ablated at the same time if sent to Ridgewood and Dr. Cerf. If a surgeon goes into this scenario it may be a judgment call to transpose the ureter but I doubt this will be necessary. In our current stats in over 85 cases and 150 procedures on the UGELAB (www.sonopath.com) our numbers are > 1 year on MST for TCC with UGELAB alone but these are not yet published numbers. I am somewhat biased since I am the co-founder of the UGELAB procedure but if she were my dog and I didn’t mind travelling to Ridgewood NJ and maybe seeing Manahattan for a few days, this is the route I would go as any urethral involvement as well as mural thickening could be addressed all at once whereas sx can’t do anything caudal to the ureters.

On the other hand Sx could be done first and UGELAB later but this compromises the closed system of the urinary tract which is important to keep the tumor localized and not potentially cross into the abdomen. the UGELAB can ablate any tumor anywhere in the bladder except when it enters the ureters which is why we do everything to “keep it off the pipes.” Its the obstruction of ureters and urethra that is usually the lethal issue.