A Novel Technique for Ureteral Catheterization and/or Retrograde Ureteroscopy after Cross-Trigonal Ureteral Reimplantation

Abstract

A criticism of the Cohen cross-trigonal reimplantation is the potential difficulty of retrograde access to the ureter. With the advent of modern endourological equipment, we devised a novel technique that obviates the aforementioned difficulty and permits even retrograde ureteroscopy. Cystoscopy is performed and a curved tip vascular access catheter is directed towards the ureteral orifice. An angle tipped glide wire with a torque device attached is passed through the catheter and directed into the orifice. The combination of the curved catheter and angled glide wire permits passage of the wire in an axis perpendicular to that of the cystoscope. Once the glide wire has been passed into the proximal ureter it is exchanged for a super stiff guide wire. The latter literally straightens the ureter permitting direct retrograde passage of a catheter, stent or rigid ureteroscope. This technique was successful in 6 children. Of the patients 4 underwent retrograde ureteroscopy with stone extraction, 1 underwent retrograde studies followed by stent insertion and 1 underwent retrograde catheterization alone for radiographic studies. It is distinctly uncommon to have to access a ureter in a retrograde fashion after cross-trigonal reimplantation. However, when required the technique described reliably permits retrograde access and should dispel fears of long-term consequences of the Cohen ureteral reimplantation.