title: Endoscopic Spatulation of the Intramural Ureter: A Technique to Prevent Stenosis of the Ureterovesical Junction in Patients Undergoing Resection of the Ureteral Orifice.
abstract: Wide resection of the ureteral orifice (UO) may result in scarring and stenosis of the ureterovesical junction (UVJ). We aimed to describe a technique of endoscopic spatulation of the intramural ureter in patients undergoing resection of the UO at the time of transurethral resection of bladder tumor (TURBT) and compare the surgical and oncological outcomes of this procedure with those of patients undergoing conventional UO resection.
  
  
  
  The clinical records of patients who underwent TURBT at a single institution were retrospectively analyzed. Patients who underwent conventional UO resection or UO resection followed by endoscopic spatulation of the intramural ureter were included in the analysis. The two groups were compared in terms of intra- and postoperative outcomes.
  
  
  
  A total of 227 patients were included in the final comparative analyses. Of them, 104 underwent conventional UO resection and 123 underwent UO resection followed by endoscopic spatulation of the intramural ureter. The two groups were comparable for demographic and clinical features. There were not statistically significant differences in terms of mean operative times. The incidence of transient postoperative hydronephrosis as well as UVJ scarring and stenosis was significantly lower in patients undergoing endoscopic spatulation of the intramural ureter. The two groups were similar in terms of incidence of vesicoureteral reflux (VUR) and upper urinary tract cancer recurrence.
  
  
  
  Endoscopic spatulation of the intramural ureter after UO resection is a safe and quick procedure that significantly reduces the incidence of transient early postoperative hydronephrosis and late UVJ stricture if compared with UO resection alone. This procedure is quick to perform, safe, and does not increase the risk of VUR.
authors.affiliation: 1 Unità Operativa di Urologia, Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli , Naples, Italy .
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Creta
authors.affiliation: 2 Clinica Urologica, Università degli Studi di Napoli Federico II , Napoli, Naples, Italy .
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.affiliation: 1 Unità Operativa di Urologia, Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli , Naples, Italy .
authors.forename: Sergio
authors.initials: S
authors.lastname: Di Meo
authors.affiliation: 1 Unità Operativa di Urologia, Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli , Naples, Italy .
authors.forename: Roberto
authors.initials: R
authors.lastname: Buonopane
authors.affiliation: 2 Clinica Urologica, Università degli Studi di Napoli Federico II , Napoli, Naples, Italy .
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Fusco
authors.affiliation: 1 Unità Operativa di Urologia, Ospedale Madonna del Buon Consiglio Fatebenefratelli di Napoli , Naples, Italy .
authors.forename: Vittorio
authors.initials: V
authors.lastname: Imperatore
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D003251:Constriction, Pathologic / Q000517:prevention & control; D003558:Cystoscopy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012306:Risk; D014513:Ureter / Q000601:surgery*; D014515:Ureteral Diseases / Q000517:prevention & control*; D018666:Ureteroscopy / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology