Endoscopic ureteroureterostomy: long-term followup using a new technique.
OBJECTIVE
We describe a new technique using a single ureteroscope and fluoroscopy for reestablishing ureteral continuity.


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.
Tsai
C K
CK
Divisions of Urology and Radiology, Loma Linda University Medical Center, Loma Linda, California, USA.
Taylor
F C
FC
Beaghler
M A
MA
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D002404:Catheterization; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015607:Stents; D014513:Ureter / Q000293:injuries* / Q000601:surgery*; D014515:Ureteral Diseases / Q000601:surgery; D018666:Ureteroscopy; D014519:Ureterostomy / Q000379:methods*