Endoureterotomy by Intraluminal Invagination for Nonmalignant Ureterointestinal Anastomotic Strictures: Description of a New Surgical Technique and Long-Term Followup

Abstract

This new endoureterotomy technique for ureterointestinal strictures following urinary diversion can be applied to any type of urinary diversion. It allows direct visualization of the stricture and stricture tissue biopsy. Intraluminal invagination makes it possible to increase the distance between the stricture, and the retroperitoneal vessels and bowels. The technique provides the control required to ensure full-thickness and full-length stricture incision. The success rate is high and it persists after long-term followup.

Retrograde endoureterotomy as a treatment option for impacted calculus in the ureterointestinal junction

“…The technique we describe is an adaptation of the endoureterotomy with intraluminal invagination described by Lovaco et al 4 for the treatment of ureterointestinal strictures. In this procedure, a balloon catheter is inflated over the stenotic area and pulled back in a retrograde manner, so that the stenotic area is invaginated and the incision is made more safely and with better visualization .…”

“…At our institution we have experience with this procedure, which is performed with rigid endoscopic material, without the need for antegrade ureterorenoscopy, being a simple technique to perform and with success rates of around 80% for the resolution of ureterointestinal strictures. 4,5 Unlike endoureterotomy with the Lovaco technique, in the clinical case we present the balloon catheter was used to prevent migration of the lithiasis, inflating the catheter in an area proximal to it, not on the ureteroileal junction, or on the lithiasis itself. Regarding the energy used for the incision, although we accept that the cut could have been made with a holmium laser, the Collins knife is an element that provides the possibility of performing mechanical traction in the incised area for better visualization, a cut that allows to distinguish between different types of tissue (ureteral thickness, fat, etc.…”

Simultaneous antegrade and retrograde endoscopic treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion

“…In the recent decades, treatment for UAS has changed drastically as a result of advances in endoscopic techniques and instrumentation [5]. Various endoscopic methods have been employed to treat UAS, such as balloon dilation [2], or endoureterotomy using cold-knife [6], electrocautery [7] or laser [8].…”