To explore the safety and effectiveness of pre dissection of bladder mucosa around the ureteral opening combined with early bladder infusion chemotherapy during radical nephroureterectomy for upper urinary tract urothelial carcinoma.

The clinical data of 5 patients encountered from January 2021 to August 2023 with carcinoma of renal pelvis or ureteral carcinoma treated in Minhang Hospital Affiliated to Fudan University were reviewed. Before undergoing radical nephrectomy, these patients underwent pre dissection of the bladder mucosa around the ureter opening and bladder infusion chemotherapy by 50 ml physiological saline and 2.0 g gemcitabine. On the 7th day after surgery, before removing the catheter, 50 ml of physiological saline and 2.0 g of gemcitabine were administered for bladder infusion chemotherapy again. All patients underwent blood analysis, blood biochemistry, urine test, urine cytology, and imaging (urinary system ultrasound, CTU or MRU) examinations every 3 months after surgery. If necessary, cystoscopy will be performed to determine the occurrence of tumor recurrence, metastasis, and other conditions.

All patients successfully completed the surgery, with good postoperative recovery and no occurrence of fever, hematuria, urinary leakage, incision infection, or incision hernia. The follow-up time of 5 patients was 6-25 months. Except for one patient with renal pelvis cancer and ureteral cancer who was diagnosed with low-grade malignant potential urothelial tumor of the bladder at the 10th month after surgery, the other four patients did not experience tumor recurrence or metastasis during follow-up.

By using the pre dissection technique of bladder mucosa around the ureteral opening, the complete resection of the distal ureter and ureteral opening is ensured, while improving surgical efficiency and reducing the occurrence of surgical complications. The performance of twice bladder infusion chemotherapy by physiological saline 50 ml+ gemcitabine 2.0 g in early intraoperative and on the 7th day after surgery is well-designed, easy to operate, and has minimal adverse reaction.