Retrograde ureteroscopy via a continent urinary diversion: surgical techniques and common pitfalls

We assessed our experience performing retrograde ureteroscopy (URS) in patients with a continent urinary diversion.

A retrospective review was performed of patients with a continent urinary diversion necessitating URS for diagnostic or therapeutic purposes from 2002 to 2013.

We identified 11 male and 1 female patients with a continent urinary diversion with a mean age of 62.5 years (27-77) who underwent 13 procedures on 17 renal units. Indication for URS was diagnostic in 10 (77%), stone disease in 2 (15%), and stricture in 1 (8%). URS was attempted a median of 6.2 years (1.3-14.5) after diversion creation. Retrograde URS was attempted in 17 renal units with 10 (59%) accessed successfully. One procedure was staged with antegrade wire access obtained before retrograde URS. Inability to identify the afferent limb or ureteral orifice one (20%), tortuosity of afferent limb two (40%), angulation one (20%), and length of the afferent limb one (20%) were causes for unsuccessful retrograde URS. Of the successfully attempted retrograde URS, 75% occurred within the past 5 years. There were no complications in the successful retrograde URS group. Ureteral stents or nephrostomy tubes were left in place postprocedure in six (50%) patients.

While technically challenging, retrograde URS can be performed successfully in patients with an orthotopic neobladder once the learning curve for the procedure is overcome.