Salvaging the obstructed ureterosigmoidostomy using an ileal interposition technique

Endoureterotomy with the Lovaco technique for treatment of ureterointestinal strictures: outcomes in an experienced center and factors associated with procedural success or failure

INTRODUCTION

The study aimed to present the outcomes of an endoureterotomy series using the Lovaco technique for the treatment of ureterointestinal strictures. Factors influencing the success or failure of this technique were also determined.

MATERIALS AND METHODS

Data were collected from all endoureterotomies for ureterointestinal strictures performed in a single-center between 2017 and 2020. Clinical variables and characteristics of the stricture were recorded in each case, and success was defined as the complete resolution of ureterohydronephrosis. Univariate analysis was used to correlate the variables recorded with procedural success or failure.

RESULTS

A total of 25 patients were recruited: 16 with strictures on the left side, 5 on the right, and 4 bilateral. With the first endoureterotomy, 52% of the cases (13 patients) were resolved, and in patients undergoing a second intervention 64% success (16 patients) was achieved. Infectious complications occurred in 23.3% of surgeries. Stricture length, poor renal function, and left side involvement were associated with endoureterotomy failure.

CONCLUSIONS

Endoureterotomy with the Lovaco technique is a useful method in the setting of ureterointestinal strictures, achieving complete resolution of the obstruction in more than 60% of cases. Factors that can negatively affect the success of the procedure include stricture length, poor renal function, and left side involvement.

Pinball calculus in a ureterosigmoidostomy

We report a complication during the treatment of lithiasis with extracorporeal shock wave lithotripsy in a patient with a ureterosigmoidostomy. This woman presented with renal colic bilaterally and renal insufficiency and was found to have an extremely mobile calculus. A significant gaseous reflux from the sigmoid colon was found to propel the solitary calculus in a retrograde fashion across the ureteroileal anastomosis up the ureter into one kidney, and then later, after re-descent to the level of the anastomosis, up into the opposite kidney. After several days of playing hide and seek with this migrating calculus, using extracorporeal shock wave lithotripsy, the patient became stone free.

Endourologic management of ureterosigmoidostomy anastomotic stricture

A 47-year-old woman presented with a stricture of a ureterosigmoid anastomosis. After through-and-through access had been established from a nephrostomy tract to the anus, an Acucise cutting balloon catheter was positioned retrograde and used to incise the strictured area. Twelve months postoperatively, the patient is doing well. Monitoring for colon adenocarcinoma continues.