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Purpose:

We assess the feasibility, technique, complications and clinical outcomes of retrograde ureteroscopy in patients with orthotopic ileal neobladder.

Materials and Methods:

We retrospectively reviewed our ureteroscopy experience to identify procedures performed in patients who had previously undergone cystectomy with orthotopic ileal neobladder urinary diversion. These procedures were reviewed and data collected regarding patient characteristics, indication for endoscopic evaluation, surgical technique, findings, complications and followup.

Results:

Eight patients with neobladder diversion were taken for 9 sessions in the cystoscopy suite for attempted retrograde ureteroscopy on 13 renal units. The indication for ureteroscopy was an upper tract filling defect, positive cytology or calculi. The ureter and renal pelvis were successfully accessed and visualized in 10 of 13 renal units. The cause of failure in the 3 unsuccessful procedures was inability to access the ureteral orifice. Mean operative time ± SD was 78 ± 34 minutes. Urothelial abnormalities were identified in 4 patients, extrinsic compression in 2 and stones in 3. In 1 patient postoperative hematuria developed, which spontaneously resolved. Fluoroscopy was essential to identify the afferent limb of the reservoir, and a directional guide wire was helpful in engaging the ureteral orifice.

Conclusions:

Ureteroscopic evaluation and treatment of upper tract abnormalities are feasible and practical in most patients with orthotopic neobladder urinary diversion. Identification of the ureteral orifice is challenging but can be accomplished with a combination of endoscopic and fluoroscopic techniques. This procedure avoids the morbidity of percutaneous access, and complications are minimal.

References

  • 1 : Urothelial tumors of the urinary tract. In: Campbell's Urology. Edited by . Philadelphia: W. B. Saunders Co.1998: 2327. chapt. 77. Google Scholar
  • 2 : Minimally invasive endourologic management of calculi in continent urinary reservoirs. Urology1994; 43: 865. Crossref, MedlineGoogle Scholar
  • 3 : Comparison of Studer ileal neobladder and ileal conduit urinary diversion with respect to perioperative outcome and late complications. J Urol1998; 160: 721. LinkGoogle Scholar
  • 4 : Combined antegrade and retrograde endoscopic approach for the management of urinary diversion-associated pathology. J Endourol2000; 14: 251. Google Scholar
  • 5 : Orthotopic bladder substitution. Curr Opin Urol2000; 10: 343. Google Scholar
  • 6 : Bladder reconstruction: a critical reappraisal. Curr Opin Urol2000; 10: 213. Google Scholar
  • 7 : Orthotopic neobladder reconstruction: findings on excretory urography and CT. AJR Am J Roentgenol1999; 172: 1213. Google Scholar
  • 8 : Long-term results of endoureterotomy for benign ureteral and ureteroenteric strictures. J Urol1997; 158: 759. Google Scholar
  • 9 : Holmium: YAG laser endoureterotomy in the treatment of ureteroenteric strictures following orthotopic urinary diversion. Tech Urol1999; 5: 45. Google Scholar

From the Department of Urology, University of Michigan, Ann Arbor, Michigan

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