C K Tsai1, F C Taylor, M A Beaghler. 1. Divisions of Urology and Radiology, Loma Linda University Medical Center, Loma Linda, California, USA.
Abstract
PURPOSE: We describe a new technique using a single ureteroscope and fluoroscopy for reestablishing ureteral continuity. MATERIALS AND METHODS: Nine patients with obliterated ureteral segments (1 bilateral) were referred for treatment, of whom 3 had concurrent ureterovaginal fistulas. Mechanism of injury included open pelvic surgery in 9 ureteral segments and ureteroscopy in 1. Ureteral continuity was reestablished using a technique combining ureteroscopy and a fluoroscopically guided antegrade snare. The affected ureteral segment was then dilated and stented using a 14/7 reversed endopyelotomy stent. RESULTS: Ureteral continuity was reestablished in all 10 consecutive attempts with this technique. At a mean followup of 16 months (range 6 to 33) all patients were stent-free without radiological evidence of obstruction. All 3 patients with fistulas were dry. In 3 patients ureteral strictures developed and required balloon dilation. Balloon dilation failed in 1 case and ultimately ureteral reimplantation was required. CONCLUSIONS: Ureteral continuity can be safely and effectively reestablished using a single ureteroscope. As a minimally invasive technique, endoscopic ureteroureterostomy should be considered before open surgical reconstruction.
PURPOSE: We describe a new technique using a single ureteroscope and fluoroscopy for reestablishing ureteral continuity. MATERIALS AND METHODS: Nine patients with obliterated ureteral segments (1 bilateral) were referred for treatment, of whom 3 had concurrent ureterovaginal fistulas. Mechanism of injury included open pelvic surgery in 9 ureteral segments and ureteroscopy in 1. Ureteral continuity was reestablished using a technique combining ureteroscopy and a fluoroscopically guided antegrade snare. The affected ureteral segment was then dilated and stented using a 14/7 reversed endopyelotomy stent. RESULTS: Ureteral continuity was reestablished in all 10 consecutive attempts with this technique. At a mean followup of 16 months (range 6 to 33) all patients were stent-free without radiological evidence of obstruction. All 3 patients with fistulas were dry. In 3 patients ureteral strictures developed and required balloon dilation. Balloon dilation failed in 1 case and ultimately ureteral reimplantation was required. CONCLUSIONS: Ureteral continuity can be safely and effectively reestablished using a single ureteroscope. As a minimally invasive technique, endoscopic ureteroureterostomy should be considered before open surgical reconstruction.