619 92224226014562119 VIDEO852207016978121223301405 Ces8507936014570127174 Urol10497936014578115180208 2021;12827936014562121178233249 25(1):15567936014562122153207231253 90–9318357936014561123187247305 SUMMARY852884014762143243345423493561 Plincelnerová1000104801315678100158208260283342396428485535585 L,1610104801315879 Čermák17131048013172124156248298344 M,20821048013195115 Fišer2221104801316082122176208 L,2454104801315878 Juhász25571048013146105164214254300 Á,2881104801317495 Kočárek8501198013155112161211242293339 J12131198013139 Inferior1294119801312481109161193215273305 vena16231198013151103160209 cava18561198013150100148197 lesion2077119801312577118139197255 as2356119801315191 a24711198013151 complica‑25461198013149105194254277299347397430 tion850134801313456114173 of1047134801316795 laparoscopic1166134801313280140190222278319367424484507555 radical1745134801314191150172221271293 nephroureterectomy20621348013167120180239270327385417468501553584636685722778868914 with8501498013179102135193 retroperitoneal1067149801313384117149206266320351374407463522575623645 lymphadenectomy1736149801312472162221280329388441499552602638694784830 Introduction:1000164301353097137179245313379432475506571638665 Upper17021648013171134198256290 urinary20191648013172106131192245279334 tract2380164801314782135187226 tumors26331648013147108202264299343 occur8501798013160113163224258 in1135179801313394 5–1012561798013165124173224 %15071798013174 of16081798013170101 all1736179801316286111 urothelial18731798013170104165200261318343367419443 tumours23431798013145106200262323357402 The27931798013163127183 prognosis850194801316091147207264322362383422 is1296194801311958 poor13781948013157115173205 due16071948013156112165 to1796194801313086 late1906194801311968100150 clinical208019480131456789146168215265287 manifestation23911948013185134191213241293333367416448470527585 resulting850209801313386128186210244268327388 in1264209801313292 late1381209801313383117170 diagnosis1576209801317093143204264324365388429 Radical20512098013166117178201251303327 laparoscopic2403209801313383144196229287329379437499523573 nephroureterectomy8502248013158112172231263319378410461495546578630680717773863910 is1784224801312060 considered18682248013146102161201223282336368420480 gold23732248013156115138198 standard2596224801313873123181240290321380 treatment850239801313467119169202292347406439 In1334239801312786 case14452398013154104145199 of1670239801316292 high1787239801316386146205 risk2017239801313760100147 tumors,2189239801313897187246279321341 retroperi‑2555239801313789124157214276331363387421 toneal850254801313491150204253276 (paraaortic,1151254801312788139171222271330363401424473493 paracaval)16692548013158108141191241291340391414443 lymphadenectomy2137254801312170161221281330391444503557607644701792839 is850269801312363 carried9382698013152103135168192246307 out12702698013161120155 Inferior1470269801312685114167199223282315 vena18102698013152105164214 cava20492698013152103151202 lesions2276269801312680121144203262303 come26042698013151108199253 as2883269801315293 a8502848013151 rare,927284801313486119173191 but11442848013171132167 serious13372848013151106139164224284325 complication16882848013159117210272297320370422456480540601 of2315284801316899 this24402848013143104127168 type2634284801314497161217 of2877284801316899 surgery850299801314199131190244276329 Clinical1000314301356593122185214264321350 case:13743143013547104150208234 We16303148013190141 present1796314801315891144185239298331 a21523148013148 case22253148013150100141195 of2445314801315686 a25563148013147 5526293148013151101 years2755314801314698148180222 old850329801316086148 female1025329801313994187239264320 patient13713298013172125160184240301336 with17333298013191116152214 oncological19733298013170132183243268329393417468521546 duplicity:25453298013171132195220244295319355410431 tumour850344801313493183242301333 of1208344801315686 the1319344801313190145 renal1489344801313082141191214 pelvis,17283448013158113137187211251271 topic2024344801313188150173222 of2272344801315685 this2382344801313291113153 presenta‑2561344801315891143184239297330381415 tion,850359801313458118178198 and10733598013160120181 an12803598013160119 oesophageal14253598013169124166227289349400461516566590 tumour20413598013143103194254314347 (epidermoid2414359801313990152176237292325417477501562 carcinoma8503748013149101134182205264324416467 classified1342374801315982132174215238265292347409 as17763748013160101 pT2pN0Mx,19033748013170115171231303358445495516 R1)24453748013165116137 In2624374801313392 2018,27423748013163117166214234 the850389801313391144 patient10183898013157107139161214271303 underwent13453898013155112171224255337389446478 total1847389801313187119168191 oesophagectomy,20623898013155108149206266325373432485534570626715761774 D228613898013167115 lymphadenectomy850404801312473166227287338399454513568619657715807855 and17304048013160119180 a19364048013160 posterior20214048013163124165202254287311371404 mediastinal245140480131100155217240290332368392451501525 lymphadenectomy850419801312372164224284334395449508562612650707798845 with17204198013188112147206 gastrooesophagoanas‑195141980131691191591952282863464014425015636236727337928439029529931025 tomosis850434801313491182241282305345 On12414348013181141 restaging1407434801314193135170221281304363424 CT18564348013170126 scan2007434801314999150208 222414348013161 years23274348013156109159191233 after2585434801315887126178210 the28204348013142101156 surgery,8504498013142101135195251284339354 there12304498013144105161194248 was15054498013190142185 a17164498013160 newly18024498013162118200225275 discovered2103449801317195136187246297351385439502 unclear26314498013169130181205261311345 finding850464801312653111171194252312 on11864648013156115 the1326464801313189143 right1494464801312953112171203 kidney,1722464801314368128186240288302 which20484648013177136158207265 was23384648013176127167 suspicious2530464801313895135195218267289347406446 of850479801315988 a9634798013151 metastatic10404798013191145179230271306357390414463 invasion1528479801312483131182223245304364 In1937479801312483 differential2045479801316184115144198230283342374398447470 diagnosis,2540479801316284134194253313354376416436 either850494801315477112172227260 abscess11364948013160121163214266308350 or15124948013168102 a16394948013160 primary1725494801316296120211262295349 kidney2099494801315782143203258307 tumor24324948013144103194255288 were27464948013190144177230 considered8505098013149106166206229289343375428489 Due13845098013169129183 to1592509801313289 the1706509801313292146 inconclusive1877509801312180129186246296319377417440490543 imagery,24455098013121111161222276308361375 we28455098013178131 performed8505248013161116148182240273364418480 another13555248013159118177211270324357 early17375248013163112144168217 CT19795248013172128 check-up,21325248013158117171222268300360420438 progres‑25955248013170103161222255307349381 sion850539801314265125186 on10625398013169130 the12185398013144105160 right1404539801314367129189223 kidney1653539801315783144205260310 and19895398013160121183 on21985398013169130 the23545398013144104160 retroperi‑2540539801314296132165224287344377402436 toneal850554801313492152206256279 lymph1155554801313382174235295 nodes14765548013168128190244286 was17875548013190141182 described19945548013170124166216249273334389451 Diagnostic24915548013181104154215275334376412435485 ureterorenoscopy850569801316095150187242276337372428490552596649709773824 including17015698013141102155180241305330391455 cold21835698013167127153217 biopsy24275698013179105167231275328 and27825698013168130194 wash-out8505848013179130171230264326385420 cytology12955848013149101140197221280342391 was17115848013181131172 performed19085848013162117149182241274365419481 Eventhough24335848013152101154213246305365424484543 the850599801313493148 histopathological1023599801316891131167224286337370430489513573634657707758781 and18295998013160119179 cytological20345998013158110149206230289351374424475498 examina‑25575998013163112162253276334385419 tion850614801313457116176 wasn´t10516148013187138179237264295 helpful,13716148013167121144205234294318336 the17326148013142101155 endoscopy19136148013161120180239280330387449497 showed24356148013149108167246299361 the28216148013142101155 expansion8506298013154103165217277318341400460 to13366298013144102 be14636298013171127 of1615629801316999 suspicious17396298013151109150211235285309368428469 appearance22346298013159121183239289321373433483536 and27966298013159119180 therefore850644801313597154189244275336372427 right1304644801314874137199234 sided1565644801315781145201266 radical18586448013148102165190242296321 nephroureterec‑22066448013176133196259293354416450506542597631687740770 tomy850659801313595189238 with11156598013192117154215 retroperitoneal1357659801314499135169229293351385410447506568625676701 lymphadenectomy2085659801313486180244306358421478539596649688747842891 were8506748013181135168222 recommended1098674801314296147205298389445505566621684 Laparoscopical18286748013160113174226260318360411469532556607658682 approach25366748013160122185218277329380440 was8506898013179130171 chosen10466898013153112172213267326 for1397689801313391124 surgeon´s15476898013145102135194248308367394429 skills2001689801314389114137160199 The22466898013156117171 surgery24426898013145103135194248281333 was28016898013183134175 complicated8507048013148104193253276298346396429480540 by14147048013157104 an15437048013146104 injury1671704801312077100156188240 of1935704801315584 the2043704801313189142 inferior2209704801312077105157189212270302 vena2535704801314698156205 cava2764704801314695143193 The8507198013151111164 situation103971980131385993151200233255313372 was14367198013176126166 fortunatelly1626719801312684116153211269318351402425448496 recognized2147719801312981131187247305327372423484 periop‑26567198013157111143166224285320 eratively850734801315386137170193244297320369 and12457348013152111171 therefore1442734801313695149182235264322355408 the1875734801313696150 primary2050734801316396120210260292345 suture24207348013144101136195227280 could27257348013152109168191251 be8507498013161116 performed9917498013170125158191249282373428489 We15257498013199151 proceeded17017498013170103160211263318379433495 according22217498013159109156213246306328387448 to26947498013143100 the28197498013143103157 rule850764801313392116170 of1045764801316898 „31169764801314196 P“1291764801316499 –14157648013165 Pressure,1505764801316597150191233291323376394 Panic,19257648013164114173196246266 Port22167648013165122155193 –24357648013164 Compress25257648013172130221282315368410451 the320389801313492145 laesion337389801312069122163184242301 immediately3699898013120108197250311333382414465488537 to426089801313187 stop437289801313873129189 the458689801313189142 bleeding475389801315781134188248270328388 and5165898013147105164 increase3203104801312382131164217266306361 the3589104801313493147 intraabdominal3761104801312382115148199249309371430521544602652675 pressure,4462104801316093146187228286318371389 keep4876104801314699154215 calm51161048013149100123213 and32031198013149107166 insert3393119801312077116169201238 another36551198013146104162194252305336 port40151198013157116148185 for4224119801312683115 additional43631198013146105164187220242300358407429 instruments4816119801312077116151183241329382440471513 to3203134801313491 fix331913480131255199 the3444134801313191145 lesion3614134801312175116139198257 On39161348013172132 our40731348013157116148 recording,4246134801313183134191224283306365425444 all471613480131477193 these4835134801313291145186240 steps5101134801313974126187228 are3203149801315082135 visible:3363149801315478118140201225279297 compression36861498013152109200261294347388429451510570 of4281149801316292 the4398149801313797151 lesion,4574149801312781122145203263282 suction48811498013145103152190213272331 of5238149801316291 the3203164801313491144 bleeding3372164801315780133187247269326386 and37821648013146104163 suture,3970164801313793127185216268285 which42791648013176134156204262 is4565164801312059 performed46481648013157111143175232264354407467 with5139164801317699132190 a32031798013150 Prolene3279179801316496154179233292347 3/036511798013163101153 suture38301798013150108143202235288 Surgery41621798013160118151211265298351 took45381798013144101162209 447731798013163 hours48611798013169128188221263 and51491798013160119180 1532031948013154100 minutes33281948013199122180239273325367 and37201948013159118178 there39231948013143103157189242 was41901948013188139180 less4395194801313387128169 than45891948013143102152211 one48251948013168127181 litre503219480131325589122174 of5232194801316797 blood3203209801316185144204265 loss3494209801312786127168 Postoperative37082098013159116157192249311366398449483506556609 hemoglobin43422098013163117207267328351411472496554 level4921209801312881131184208 was51542098013183134175 sufficient3203224801314199127155183233256309368401 and36292248013150109170 there3824224801313393147179232 was40812248013179130171 no42772248013159118 need44202248013159113168230 for4675224801312887120 transfusion4820224801313467118176217248308348370429489 The32032398013151112167 complications33952398013158115206267291313363414447470529589629 are4050239801315991144 classified4219239801315881131172213235262289343404 as4649239801315999 Clavien-Din‑4774239801317194144193217271330365438462520555 do32032548013160119 133472548013158 Intramural3444254801312886119152203293351384435458 part39272548013166117149187 of4139254801316393 the4257254801313897152 ureter4434254801316395148182234266 was47262548013183134175 removed4926254801313790180239289342403 by32032698013161109 Collins33372698013171128152175197256297 knife36592698013154115138167221 The39232698013159120174 subse41222698013149107167208263 quent44102698013167126180239271 postoperative47072698013168128170205262324379411462496519569622 period32032848013162119153178239303 was35322848013191144186 uncomplicated37452848013170131182241335398423447498551586640703 The44952848013162126182 drainage47032848013171105158182243295357413 was51432848013191144186 removed3203299801313387179239290344407 on36352998013169130 the37912998013144104160 the39772998013144104159 third41622998013144105128161222 day44092998013171122170 and46052998013160120182 the48132998013144104160 patient49992998013171123157181236296330 was32033148013179130171 discharged3399314801316184124174233283315374428489 on39143148013159119 the4058314801313594148 eighth4232314801315477137196229288 day45453148013161111159 On47433148013175135 the4904314801313594148 histo‑5077314801316083123159216252 pathological32033298013161112145204264288347408431480531555 examination,37833298013159108158248271330380413436495554574 there4382329801313998153185238 was46453298013185136177 a48473298013155 sqamous49273298013143103153243302362402 carcinoma32033448013151104138188212273335430482 of37123448013170102 the38403448013146108164 renal4031344801314499161213238 pelvis42953448013174131156209234276 described,45983448013172129172224259284347404469489 with51143448013192117154215 positive32033598013161121162185219242292345 lymph3574359801312170161222282 nodes38813598013157116178232273 (pT3pN2,4179359801312789134189249320372391 grade4595359801315891142202256 3)4876359801315278 Primary4995359801315485109199249281334 sqamous32033748013141102152242302362402 carcinoma36313748013158109142190213271331422472 of4129374801316897 the42523748013143102157 renal4434374801314295154204228 pelvis46873748013170125149200224264 is4976374801313373 a50743748013160 rare5159374801313385117170 histopathological3203389801315982122157215276327360419479503562623646696746770 finding3998389801313158116177200258319 It4362389801312762 appears44493898013154115176231280313355 in4829389801312786 only49403898013163123146195 151603898013158 %52443898013185 of3203404801315988 all3316404801316083106 urothelial34474048013168100158191251305329351401424 malignancies,389640480131100150173196256315365424474497550592612 but45334048013170129164 it4722404801313267 is4814404801313272 the49114048013143103157 most50934048013199159200236 frequent3203419801312963115177235289348381 histopathological3609419801315780120155212274325358417477501560621644693744768 variation4402419801314798131154204237260319379 of4806419801315686 urothelial4917419801315688146180239293317339388412 tumours3203434801313492182241300332374 The36224348013149109163 patient38104348013158109142165218277310 was41454348013176127167 passed43374348013158109150190244305 to4667434801313188 the4780434801313190144 complex49494348013146103194254278332380 oncological32034498013158116165220244302362384432482504 center,3731449801314697154186237269282 where40384498013175133186218269 she4332449801313794147 was45044498013175125164 already4693449801314668100151199258306 treated5024449801313062114162194245305 for3203464801312988122 the33514648013143103158 earlier35354648013163113146170193248281 diagnosed3842464801316993143204264324366421483 oesophageal43514648013168124166226288349400461516566589 tumour49664648013144103194255315348 She32034798013152111166 received3395479801314296147200224275329391 adjuvant38124798013160121145204255307367401 chemotherapy42384798013159119174266326360420475509561622671 (Cisplati‑49354798013139101124165226251302336359394 num32034948013159118209 +34384948013175 Gemzar,35384948013179134225271324356371 539344948013164 cycles40234948013159111161184239280 in4329494801313292 total)44464948013144101135186210240 The47284948013161123177 adjuvant49314948013159121144203254305365398 chemotherapy32035098013149107161250309342400454486537597644 was38725098013176127167 eventually4064509801315099152210242301350373395444 interrupted4533509801312078110162194227286346379431491 due50495098013157114168 to5242509801313187 hematotoxicity32035248013159113203253287344377434481504554577611663 The39065248013158119173 follow-up4104524801313694118141200280314374435 CT45645248013169125 scan4714524801314898149207 revealed4947524801313991141194243267321382 generalisation32035398013159111168221252302324345384434466488545603 to3830539801313085 lungs,3939539801312076133192231249 right4212539801312952110167199 suprarenal4435539801313793151183233264315372420443 gland4902539801315577125182241 and51675398013146103162 paraaortic32035548013161112144195245304337375399448 lymph3676554801312574165226285 nodes39875548013160119180234276 Conclusion:33535693013564125188238267329376404466529555 Retroperineal39305698013155107139170225285338368390446498545567 lymphadenectomy4520569801311966155213271319377429486538586621676764809 represents3203584801313283143174225265318375407448 an36755848013145103 important38025848013119107166224256293342399431 step4256584801313772122181 in4461584801311976 surgical4561584801313793124181203251300322 treatment4907584801313061112160191280333390422 of3203599801315886 different3313599801315576105134186217267325356 urological3692599801315485141164221280302349398420 tumours4136599801312986174232289320360 however45205998013154112189240288340370 vena4914599801314596154202 cava5139599801314594141190 laesions3203614801312473127168189248307347 can35756148013158108167 come37666148013158115206260 as40506148013159100 a41746148013159 complication42576148013150107198258282304353403436459517577 of4858614801316897 surgery49796148013150107139198252284336 There32036298013151111164195247 can3474629801314595153 be36516298013157111 other3786629801315587145198230 iatrogenic404062980131196799131188248301359380428 causes,4493629801314595152191244284303 for4820629801312582114 example4958629801315098147236295318371 ureteral3203644801315890141174225257307329 stent3556644801314781132190222 insertion3802644801312987126179210248270327386 Inferior4231644801312987114166198220278310 vena45656448013156108166214 cava48046448013155104152202 lesions5030644801312982122143201260299 can3203659801314896152 be33786598013155107 fatal3508659801312472103151172 and37036598013144100158 the3883659801312985137 best40426598013155108146179 way42446598013174121166 to4433659801312983 handle45396598013153100156213234285 this4847659801312985106143 compli‑5013659801314498185242264284316 cation3203674801314999131153211269 is3496674801312059 to3579674801313086 recognize3689674801312981130186247304326370421 the4134674801313189142 laesions4300674801312069121162183241299339 perioperativelly46636748013157111142165223283337368418450472522574596618666 and32036898013150108167 to3394689801313490 perform35086898013161115146178236268358 primary3890689801316092115204253284336 suture4250689801314197131188220271 KEY32047184014770134206 WORDS343671840147106190261346409 Inferior3203734801312379106157188209266297 vena3523734801314596152200 cava,3746734801314493139188206 nephroureterectomy,39757348013154106164221252307363394444476526556607655690745833878890 periopera‑48897348013155108139160217276328359408440 tive3203749801313456105157 vascular3384749801314696135184241263312343 lesion,3751749801311972112133191249267 retroperitoneal4042749801312981114145202262316347369403459517570618640 lymphadenec‑4706749801312068158217275324383436494547596623 tomy,3203764801313490180226239 upper34667648013158118178232264 urinary3754764801315889112169218249301 tract4079764801313466116165201 tumours4304764801313492180239297328369