Experience with 45 Consecutive Patients with Neobladders Undergoing Retrograde Ureteroscopy for Upper Tract
Nirmish Singla1, James E Montie1, Cheryl T Lee1
1Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas (NS), and Department of Urology, University of Michigan, Ann Arbor, Michigan (JEM, CTL, JSW, GJF).
Urology Practice
|January 14, 2020
Summary
Retrograde ureteroscopy is a feasible method for evaluating upper tract issues in patients with orthotopic neobladders. This technique offers a practical alternative to percutaneous access, minimizing complications.
Area of Science:
- Urology
- Surgical Techniques
- Oncology
Background:
- Orthotopic neobladders are surgically created urinary diversions.
- Upper tract abnormalities require effective diagnostic methods.
- Evaluating these abnormalities can be challenging in patients with neobladders.
Purpose of the Study:
- To assess the feasibility, technique, complications, and outcomes of retrograde ureteroscopy.
- To determine the effectiveness of retrograde ureteroscopy in diagnosing upper tract abnormalities in patients with orthotopic neobladders.
Main Methods:
- Retrospective review of retrograde ureteroscopic procedures in patients with orthotopic ileal neobladder diversions.
- Data collection on patient characteristics, indications, technique, success rates, and complications.
- Analysis of success rates based on neobladder type (Hautmann, Studer, unascertained).
Main Results:
- Successful ureteric and renal pelvis instrumentation in 80.4% of cases.
- Higher success rates in Hautmann-type neobladders (85.3%) compared to Studer-type (50%).
- Confirmed malignancy in 35.9% of filling defects, 100% of positive cytology, and 85.7% of positive fluorescence in situ hybridization cases.
Conclusions:
- Retrograde ureteroscopy is a feasible and practical approach for upper tract evaluation in orthotopic neobladders.
- Ureteral orifice identification and cannulation can be challenging but manageable with fluoroscopy.
- This method avoids the morbidity associated with percutaneous access, with minimal complications.
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