408

| The Surgical Technologist | DECEMBER 2017 548 Transitional cell carcinoma, or TCC, is a type of malig- nant cancer found in the flexible transitional tissue of the renal pelvis and ureter. While rare, it is most often found in people with a genetic predisposition, smokers, analgesic abusers or people employed in the chemical processing or coal industries. Men are more likely to develop TCC than women as are Caucasians over other races. Common symp- toms include hematuria, flank or back pain, weight loss, fatigue and dysuria. 2 There are multiple types of non-metastatic tumors that can affect the kidneys, including oncocytoma. Predomi- nantly found in men older than 60, oncocytoma typically presents as a single large tumor in one kidney. Hypertension is a disease state where the force of the blood through the arteries is increased due to arteriosteno- sis and/or increased blood volume, causing damage to the blood vessels. High blood pressure can weaken the blood vessels in the kidneys, resulting in the compromised waster excretion and fluid exchange. Extra fluid in the system can increase blood pressure, leading to greater kidney damage. This cycle can continue until the kidneys can no longer keep up with the filtration demands of the body, which results in renal failure. 5 End stage renal disease, or ESRD, occurs when the kid- neys are unable to keep up with the filtration and excre- tion needs of the body. Without intervention, ESRD is fatal. Treatment options are kidney transplant or hemodialysis. 1 D I A G N O S T I C T E S T I N G To diagnose ureteral TCC, the physician will use a combina- tion of exam and history data, radiographic imaging, urinal- ysis and indirect visualization via cystoscopy/ureteroscopy. Radiographic imaging can include a CT scan, intravenous (IV) or retrograde urography and/or ultrasonography. CT scans are useful for distinguishing renal calculi from soft tissue masses. Urography, whether administered through the circulatory system or transurethral, uses contrast medium and fluoroscopy to map the path of the urine through the urinary tract. It is especially useful in highlighting strictures or dilatation of urinary structures. If the patient only has one kidney, IV urography is contraindicated. A urinalysis is used to confirm the presence of hematuria and to test for a urinary tract infection. Cytological examination of urine samples for shed TCC cells is not a reliable diagnostic test for ureteral cancer unless or until it becomes a high stage cancer. 4 P R E P A R A T I O N F O R S U R G I C A L I N T E R V E N T I O N For this case, in order to successfully complete the right total ureterectomy and transurethral resection of the right ureteral orifice, a series of smaller procedures were required. The surgeon and team prepared for a cystoscopy, ureteroscopy, retrograde urography, ureteral catheter inser- tion, ureteral dilatation and bladder biopsy. The procedure progressed in two stages: the first stage included all of the transurethral procedures while the second stage included abdominal procedures. Two setups were required to pre- vent cross-contamination. Repositioning and redraping also occurred between stages one and two. The required instruments, supplies and equipment for both stages had to be ready in the room before the proce- dure began, which required additional time to gather the needed items and to prepare both setups. Supplies com- mon to both procedures included a suction apparatus and tubing, sterile towels, sterile gowns and gloves, an electro- surgical dispersive pad, sequential compression stockings, positioning devices and prep kits. S U R G I C A L I N T E R V E N T I O N The patient is intubated and general anesthesia is given. The transurethral portion of the procedure is carried out with the patient in the lithotomy position with slight Tren- delenburg (to shift the abdominal organs away from the bladder) using padded Allen stirrups. A foam headrest is used and the arms are secured to the arm boards and posi- tioned at an angle of less than 90 degrees. The pads are used to protect the ulnar nerves bilaterally. For the abdom- inal portion of the procedure, the patient is placed in the Transitional cell carcinoma, or TCC, is a type of malignant can- cer found in the flexible transi- tional tissue of the renal pelvis and ureter.