Retrograde ureteroscopy via a continent urinary diversion: Surgical techniques and common pitfalls - Abstract

Introduction: We assessed our experience performing retrograde ureteroscopy (URS) in patients with a continent urinary diversion.

Methods: A retrospective review was performed of patients with a continent urinary diversion requiring URS for diagnostic or therapeutic purposes from 2002-2013.

Results: We identified 11 male and 1 female patients with a continent urinary diversion with a mean age of 62.5 years (27-77) who underwent 13 procedures on 17 renal units. Indication for URS was diagnostic in 10 (77%), stone disease in 2 (15%), and stricture in 1 (8%). Ureteroscopy was attempted a median of 6.2 years (1.3-14.5) diversion creation. Retrograde URS was attempted in 17 renal units with 10 (59%) accessed successfully. One procedure was staged with antegrade wire access obtained prior to retrograde URS. Inability to identify the afferent limb or ureteral orifice 1(20%), tortuosity of afferent limb 2 (40%), angulation 1 (20%) and length of the afferent limb 1 (20%) were causes for unsuccessful retrograde URS. Of the successfully attempted retrograde URS, 75% occurred within the past 5 years. There were no complications in the successful retrograde URS group. Ureteral stents or nephrostomy tubes were left in place post procedure in 6 (50%) patients.

Conclusion: While technically challenging, retrograde ureteroscopy can be performed successfully in patients with an orthotopic neobladder once the learning curve for the procedure is overcome.

Written by:
Rivera ME1, Krambeck AE.   Are you the author?
Mayo Clinic, Urology, 200 First St SW, Rochester, Minnesota, United States.  

Reference: J Endourol. 2014 Feb 26. Epub ahead of print.
doi: 10.1089/end.2014.0018

PubMed Abstract
PMID: 24571679 Endourology Section