Percutaneous ureterocystostomy and ureteroneocystostomy

Percutaneous ureterocystostomy or ureteroneocystostomy is advocated as a simple, minimally invasive alternative to the extensive surgical procedures typically used in the repair of a severed distal ureter. A steerable sheath is introduced via a percutaneous nephrostomy and is advanced into the distal ureter. Reentry into the bladder is effected by a perforating guidewire (transseptal stylet). This technique was attempted in 21 patients. It was effective in 12 of 13 patients whose ureters had been severed during vaginal hysterectomy and in four of five patients who had dehiscence of an anastomosis of the ureter to a bladder pouch (uretero-Boari anastomosis). The procedure, however, failed in all three patients who had dehisced surgical ureteroneocystostomies. This experience suggests that percutaneous ureteroneocystostomy is a feasible alternative to surgery. An adequate residual length of the pelvic ureter and preservation of its vascular supply are the major factors predisposing to the success of this technique.