Long-term experience with endoscopic transvesical ureterotomy

Abstract

Summary. Endoscopic Transvesical Ureterotomy (ETU), a technique which involves cutting onto a ureteric catheter with a Collings knife and extending the incision through bladder wall and extravesical fat for several centimetres to dilated proximal ureter, was used for refractory ureteric obstruction in 23 patients followed for up to 10 years. The aetiology of obstruction was radiotherapy in six patients, malignancy in six (three of whom had had previous radiotherapy), ureteroscopically inaccessable impacted calculi in seven, scarring following resection of bladder tumour in one and severe obstruction following gynaecological surgery in two other patients. Another had a post-tuberculous lower ureteric stricture.In only one instance was the procedure ceased prematurely due to small volumes of irrigant returned with intermittent bladder emptying. Lengths of ureterotomies ranged from 1.5 to 6.5 cm with postoperative stenting employed in half the cases. In four patients, ETU was performed ‘blindly’, with relief of obstruction in three. The results related directly to the underlying pathology. Persisting tumour re-obstructed within months and radiation strictures were prone to recur, sometimes contralaterally, even years afterwards. However, acknowledging these limitations and the fact that induced vesico-ureteric relux may confound urodynamic interpretation, this simple yet effective operative technique is strongly recommended for suitable cases.