EL on TCC resectable and non in borderline tcc case near ureter
Hello Lena,
EL on TCC resectable and non in borderline tcc case near ureter
Hello Lena,
The resection is the surgeon’s call depending on abilities. My query into boarded surgeons is that most like to have at least 1cm of clean tissue between the tumor to resect and the right ureteral papilla which is most cranial. This case shown is not possible to resect. 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 VH in Ridgewood, NJ and Dr. Cerf (www.ridgewoodvet.com).
[videoembed id=6896] [videoembed id=6897]
If a surgeon goes into this scenario it may be a judgement 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 cofounder of the UGELAB procedure but if she were my dog and i didnt mind traveling 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 cant 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.” It’s the obstruction of ureters and urethra that is usually the lethal issue.
In this particular case shown here the right ureter was obstructed by the mineralizing TCC and you can see the before and after scenarios from the still images. The videos show the US-guided laser ablation procedure when 2/3 of the tumor was ablated and then the end result with the collapsed and functional ureter that is live and kicking:) We like to get to these before the ureter is obstructed because there is only 0.2-0.3 cm of wall to shave against here so working in tight spaces.