Endoscopic ureteroneocystostomy for complete obstruction at the ureterovesical junction.

Abstract

We evaluated the technical and long-term success of endoscopic ureteroneocystostomy in patients with complete obstruction of the distal ureter. We treated 7 patients with complete obstruction at the ureterovesical junction via a combined antegrade and retrograde endoscopic approach (endoscopic ureteroneocystostomy). The etiology of obstruction included ureteroscopy for ureteral calculi in 3 patients and previous resection of bladder tumors or the prostate in 4. Six patients had proximal drainage with a percutaneous nephrostomy catheter at referral. An antegrade approach was used for localization, and a retrograde approach was used for direct visual ureteral meatotomy or ureterotomy with the endoscopic scissors or a cold-knife urethrotome. Continuity at the ureterovesical junction was restored in all 7 patients, and 6 are currently stricture-free with followup of 14 to 64 months. The sole failure in this series was due to recurrent invasive transitional cell carcinoma. Endoscopic ureteroneocystostomy is a safe and effective treatment of complete obstruction of the ureterovesical junction.