Identification of the narrow lumen of the ureter using a Fogarty catheter during laparoscopic pyeloplasty

Abstract

It is difficult to identify the narrow sites of the ureter from the outside while carrying out laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. We developed and named a new method, the Fogarty test, to identify the narrow sites of the ureter using a Fogarty catheter. A 4-to 5-Fr Fogarty catheter was inserted through an incision in the pelvis to the proximal ureter, inflated with air and withdrawn gently to determine resistance. The narrow lumen of the ureter was identified under direct vision and spatulated by laparoscopic scissors. This procedure was carried out repeatedly until the ureter was fully spatulated. By using the Fogarty test, we can visualize the narrow position and length of the ureter under direct vision, and confirm whether it is fully spatulated or not. This technique is very simple and easy to carry out. We believe it is useful for sufficient spatulation of intrinsic ureteral stricture, especially in patients where multiple narrow sites exist.

A Rapid Special Staining Technique for Identification of Normal Ureter by Frozen Section in Children With Ureteropelvic Junction Obstruction

“…2,3 Several authors have expressed concern that the microscopic abnormally in the ureteral segment below the UPJ may be longer than the visible narrow segment and failure to excise adequate length of this adynamic segment during surgery may be a cause of failure. 4,5,8 Harish et al 4 recommended that the ureter should be excised 8 mm beyond the visible distal limit of the narrow segment to discard the aperistaltic segment. Identifying the normal distal ureter intra operatively is a more scientific way than excising a longer segment of ureter which may result in tension during anastomosis.…”

“…4 Inadequate excision of the narrow segment has been proposed as a cause of failure in 5% to 7% of cases. 4,5 Although some authors have claimed that there is no sound anatomical basis for existence of an actual UPJ, 6 some have proposed even a muscular sphincter at UPJ. 7 The exact etiology of UPJO is still unknown, and intraoperative inspection of the UPJ alone may not be enough for accurate determination of abnormal UPJO segment.…”