408

DECEMBER 2017 | The Surgical Technologist | 547 RightTotalUreterectomy withRightTransurethralResectionofUreteralOrifice L E A R N I N G O B J E C T I V E S s Examine the anatomy of the urinary system s Review the pathophysiology affected by the patient’s condition s Recall the stages of surgical intervention performed during this case s Discuss why this case had multiple procedures performed s List the multiple equipment sets needed for this procedure Dawn MP Marcotte , cst P A T H O P H Y S I O L O G Y M alignant ureteral neoplasm and the potentially resulting tumor can disrupt a number of urological processes in the otherwise healthy patient. Stricture or occlusion of the ureter caused by a filling defect can lead to reflux nephropathy, a diseased state where the urine backflow damages the kidney tissue. 6 Metastasis to the urinary bladder is common, occurring in 30%-75% of all ureteral cancer patients. Cancer cell seeding through the blood also may involve the liver, lungs or bone surrounding bone. 4 If the patient has not had a previous nephrectomy, reflux nephrop- athy is not a concern; however, antegrade metastasis is a possibility. Comorbid conditions may include a history of transitional cell car- cinoma of the bladder, benign renal neoplasm resulting in a right nephrectomy, hypertension, end stage renal disease (ESRD) and hemodialysis to compensate for kidney failure. A Case Study Five year’s prior, a 67-year-old male had his right kidney removed due to the presence of a large renal mass. With no evidence of pathological involve- ment, the right ureter was left in situ. However, more recently, the patient was diagnosed with Stage 1 TCC of the trigone of the urinary bladder, which was resolved due to surgical intervention. Chronic hypertension has led to end stage renal disease in his left kidney and he currently undergoes hemodialy- sis. Now the patient has presented with hematuria and right flank pain. After diagnostic testing, it was determined that there has been a recurrence of TCC, this time in the right ureter. The surgeon opted for a total right ureterectomy and transurethral resection of the right ureteral orifice.