Antegrade Percutaneous Flexible Endoscopic Approach for the Management of Urinary Diversion-Associated Complications

Abstract

We present our experience in the minimally invasive management of postoperative complications associated with urinary diversions using an ureteral access sheath (UAS) in an antegrade approach. From 2005 to 2011, 21 antegrade flexible ureteroscopies (F-URS) were performed in 17 patients with a urinary diversion. Urinary diversions in this population consisted of ileal conduits, orthotopic neobladders, catheterizable pouches, and an ureterosigmoidostomy in 9, 5, 2, and 1 patients, respectively. The most important reason for treatment was recurrent upper urinary tract infection. The indication for intervention was stone disease in 15 procedures and strictures in 6 cases. In two patients, "staged-therapy" was performed. Using UAS in an antegrade approach was the main concept. A nephrostomy tube was already in place in 14 (66.6%) procedures, which was the access route used. Successful puncture was performed in all other patients. Eighty percent of patients were rendered stone free after the first antegrade session. Moreover, all strictures were successfully managed by dilation. In two sequential procedures in a patient, there was an inability to perform stone treatment because of abnormal position of the ureter (kinked), which did not allow the ureterorenoscope to pass. All other procedures were uneventful. Postoperative complications were reported in four procedures. There was significant urinary tract infection in two patients as well as an obstructed nephrostomy tube in two patients. An antegrade endoscopic procedure using UAS in patients who present with stones or ureterointestinal stricture as late complications of urinary diversion is a feasible, well-tolerated technique, especially when using smaller access sheaths.