Endoscopic treatment of ureterovesical junction obstructive pathology: A description of the oblique meatotomy technique and results

Abstract

original research E728Cite as: Can Urol Assoc J 2013;7(11-12):e728-31. http://dx.doi.org/10.5489/cuaj.496 Published online November 8, 2013. AbstractBackground: Benign obstructive pathology of the ureterovesical junction includes congenital and acquired illnesses. The objective of this study was to describe the endoscopic oblique meatotomy technique using scissors and cold cutting to treat benign obstructive pathology of the ureterovesical junction. Methods: From 2007 to 2012, we treated 18 patients with obstructive pathology of the ureterovesical junction (5 megaureters [3 with lithiasis], 4 iatrogenic stenoses, and 9 ureteroceles with lithiasis). In all cases, oblique meatotomy was performed using endoscopic scissors through an 8.5 Ch ureteroscope. The mean follow-up for all patients was 3 years. Pain, grade of hydronephrosis, and occurrence of vesicoureteral reflux were evaluated before and after treatment. Results: The mean endoscopic treatment time was 13.4 minutes. The procedure was performed on an outpatient basis with 6 hours of hospital admission, and a double J stent was inserted for 6 weeks. We achieved treatment success in 94.5% of patients after 3 years of follow-up. Only 1 patient presented with vesicoureteral reflux at 12 months after treatment; however, this condition did not require further treatment. Overall, 100% of patients remained free from lithiasis. There are 2 main limitations: the small number of patients and the lack of another group to compare the results of this technique; however, the aim of this work was to communicate a new technique to treat ureterovesical junction stricture Interpretation: Oblique ureteral meatotomy is a safe and effective treatment for benign obstructive pathology of the ureterovesical junction and has a low index of complications.

The Dilemma of Ureterovesical Junction Obstruction

“…Miguel arrabal-martin and coworkers introduced an endoscopic oblique meatotomy technique by scissors using an 8.5f ureteroscope in an outpatient basis with 6 weeks DJ insertion (15). They reported an acceptable 3-year follow-up with minimal complication rates.…”

"Killing two birds with one stone": endoscopic management of PUJ and VUJ obstructions with a renal stone in a congenital solitary kidney

“…Historically, both VUJ and PUJ obstructions were managed with open or laparoscopic procedures rather than endoluminally as they have more durable results. 6,7 However, technical improvements, such as endoscope miniaturisation, improved deflection mechanisms, enhanced optical quality and more effective accessories, have led to an increased efficacy of the endoluminal approach and its consideration as first line management. [6][7][8] Lower pole renal stones can be managed either endoluminally with ureterorenoscopy and laser lithotripsy or by percutaneous nephrolithotomy (PCNL).…”

“…6,7 However, technical improvements, such as endoscope miniaturisation, improved deflection mechanisms, enhanced optical quality and more effective accessories, have led to an increased efficacy of the endoluminal approach and its consideration as first line management. [6][7][8] Lower pole renal stones can be managed either endoluminally with ureterorenoscopy and laser lithotripsy or by percutaneous nephrolithotomy (PCNL). 9 Extracorporeal shockwave lithotripsy is generally reserved for smaller stones in this position.…”

Minimal-invasive management of urological complications after kidney transplantation

“…Success rate of 94.4% after ostium incision with a cold knife in the distal US after a FU of 3 and 24–36 months ( n = 18; [ 50 ])…”

“…The incision was performed after placement of a guidewire or ureteral catheter via endoscopic scissors and cold cutting in medial and dorsal direction (5 o’clock position on the right side and 7 o’clock position on the left side). The procedure turned out to be a safe and effective treatment: all but one patient were treated on an outpatient basis, the grade of hydronephrosis decreased or disappeared after 3 months and the preoperative pain resolved completely in 17 out of 18 cases after 3 and 24–36 months [ 50 ].…”