Management of complete ureteral obstructions with a transluminal puncture technique.
BACKGROUND
The traditional delayed treatment of iatrogenic complete ureteral obstruction is open surgery. An easy endourological technique, transluminal re-canalization of the ureter by guide-wire puncture under fluoro-endoscopic control, which has been performed on 4 patients, is described.


METHODS
With the guidance of C-arm fluoroscopy, by moving the C-arm to different planes, the tip of the ureteroscope is directed to the correct plane to meet the obliterated proximal end of the ureter and under direct vision, transluminal puncture is performed using the stiff end of a 0.035-inch guide wire. Once the stiff end of the guide-wire is in the lumen of the proximal ureter, an ureteral catheter is introduced over the guide wire, the guide wire is then removed and reinserted through the ureteral catheter with its soft end leading and a double J catheter is inserted. Ureteral stricture, if later encountered, is treated with balloon dilatation.


RESULTS
Continuity of the ureter was restored in all 4 patients. The double J stents were removed 6 weeks later and a retrograde pyelography revealed resolution of the hydronephrosis without extravasation of urine.


CONCLUSIONS
Although a very satisfactory result was achieved in our cases, more cases are needed to show if it can be an alternative to conventional surgical repair. However, we believe that this minimally invasive technique can be used for short obliterated ureteral segments and neither delays nor does it preclude further management using open surgery.
Egilmez
Tulga
T
Department of Urology, Adana Clinic and Research Center, Baskent University School of Medicine, Adana, and Department of Urology, Baskent University School of Medicine, Ankara, Turkey. tulgaegilmez@yahoo.com
Guvel
Sezgin
S
Kilinc
Ferhat
F
Yaycioglu
Ozgur
O
Ozkardes
Hakan
H
D000328:Adult; D002404:Catheterization / Q000379:methods*; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000628:therapy*; D018666:Ureteroscopy