Retrograde blind endoureterotomy for subtotal ureteral strictures: a new technique

Laser endoureterotomy and endopyelotomy: an update

PURPOSE

Although minimally invasive approach is one of the first-line treatment choices for ureteral strictures, there are still controversies on the ideal method to treat this entity. The objective of this update was to define the level of evidence around endoscopic treatment of ureteropelvic junction (UPJ) and ureteral strictures.

METHODS

We reviewed the current available literature on the PubMed database from the last decade up to May 2014 on laser endoureterotomy and endopyelotomy.

RESULTS

The level of evidence for the endoscopic treatment of UPJ and ureteral strictures is low. Despite this, it appears that endoureterotomy and endopyelotomy performed mainly with Ho:YAG laser achieve good success rates with minimal perioperative morbidity.

CONCLUSIONS

Laser endoureterotomy and endopyelotomy should be considered a reasonable treatment option in selected patients.

Endoureterotomy as the initial management of concurrent ureteropelvic and ureterovesical junction obstruction after failed conservative therapy

OBJECTIVE

To present the results of our experience with endoureterotomy as the initial management of ureterovesical junction obstruction (UVJO) with coexisting primary or secondary obstruction at the ureteropelvic junction (UPJO) level.

METHODS

A total of 490 children with 561 ureterorenal units were referred to our center for further management of UVJO. Of these, 47 ureterorenal units had concomitant UPJO. All patients underwent endoureterotomy. Patients were monitored by performing clinical examinations, urine culture, ultrasonography, and radionuclide renal scan.

RESULTS

Mean procedure time for endoureterotomy was 20 minutes (range, 14-33 minutes). No postoperative complications were observed. With a mean follow-up of 27 months, 39 of the 47 ureters with concomitancy (82.97%) showed resolution of both pathologies after the initial endoureterotomy, and 4 patients experienced resolution after redo endoureterotomy, with an overall success rate of 91.48%. Three ureterorenal units (6.38%) underwent further ureteral reimplantation. Pyeloplasty was performed on 3 ureterorenal units (6.38%), which led to complete resolution in all.

CONCLUSION

Performing initial endoureterotomy for the management of UVJO concomitant with UPJO provides promising results in spontaneous resolution of UPJO and complete resolution or decrease in hydronephrosis and can be proposed as an effective and safe temporizing alternative in selected patients.

Concomitant endoureterotomy and dextranomer/hyaluronic acid subureteral injection for management of obstructive refluxing megaureter

PURPOSE

To present the results of our experience with combined endoureterotomy and endoscopic injection of dextranomer/hyaluronic acid (Deflux) for the treatment of primary obstructive refluxing megaureter (PORM).

PATIENTS AND METHODS

Eighteen children (12 female, 6 male; mean age-14 months) with 20 PORM units underwent concomitant endoureterotomy and endoscopic subureteral Deflux injection. All patients underwent endoureterotomy at the 6-o'clock position with insertion of a 3F Double-J ureteral stent into the obstructed segment of ureter and subureteral injection of Deflux at the 5-o'clock and 7-o'clock positions. The Double-J stent was left in place with its distal tip fixed with a single knot to the external genitalia for easy removal after 1 week. Patients with refluxing nonobstructive ureter on the contralateral side of the PORM unit (seven children) underwent simultaneous endoscopic subureteral injection of Deflux. Voiding cystourethrography (VCUG) was performed at 6 months, and ultrasonography was performed at 1 week 3, 6, and 12 months postoperatively.

RESULTS

With a mean follow-up of 30 months, the procedure was uneventful in all patients. Follow-up VCUG showed no evidence of reflux in 15 ureterorenal (75%), significant decrease in reflux grade in 2 (10%), and no change in 3 (15%) in the endoscopic treated PORM units. No evidence of reflux was observed in the treated contralateral refluxing nonobstructive ureters. Ultrasonography revealed no ureterovesical junction obstruction. In 19 ureterorenal (95%) units, there was a complete resolution or decrease in hydroureteronephrosis.

CONCLUSIONS

The results of this study demonstrate that combined endoureterotomy and subureteral injection of Deflux is safe and effective in the treatment of PORM in selected patients.