Retrograde ureteral and renal access in patients with urinary diversion.

摘要

OBJECTIVES: To present our experience with retrograde ureteral and/or renal access in patients with urinary diversion. Retrograde ureteral access may be indicated for treatment of malignancy, ureteroenteric anastomotic stricture disease, or nephrolithiasis, and, in patients with previous urinary diversion surgery, can be technically challenging. METHODS: We retrospectively identified patients undergoing attempted retrograde ureteral access after urinary diversion surgery. The demographic information, diversion type, indication for retrograde access, success or failure of access, and intra- and postoperative complications were recorded. RESULTS: From 2003 to 2008, 21 renal units (15 patients) with previous urinary diversion surgery underwent attempted retrograde ureteral access. The indications for retrograde access included treatment of nephrolithiasis in 5, ureteroenteric anastomotic stricture in 9, upper tract filling defects in 3, positive cytology findings in 1, and known upper tract malignancy in 3. We made 28 retrograde access attempts. Of these, 21 (75%) were successful. The success rate for each type of urinary diversion was 90% (9/10) for orthotopic neobladders, 73% (11/15) for ileal conduits, and 33% (1/3) for Indiana pouches. All 6 attempts to access the renal units for ureteroscopic management of suspected upper tract malignancy were successful. The access attempts were less successful in 5 of 10 patients (50%) with anastomotic stricture disease. No complications were reported. CONCLUSIONS: Retrograde access in patients with urinary diversion is feasible and safe. The risk of failed access is increased in patients with ureteral anastomotic stricture. The diagnosis and/or treatment of upper tract urothelial carcinoma and stone disease can be readily performed with retrograde ureteroscopic techniques.