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Percutaneous transvesical ureteroscopy for removal of distal ureteral stone in reimplanted ureter
R P Santarosa1, T W Hensle, R Shabsigh
1Department of Urology, Columbia-Presbyterian Medical Center and Babies Hospital, New York, New York.
Insights
Transverse ureters from cross-trigonal reimplantation can complicate ureteroscopy. Percutaneous transvesical ureteroscopy offers a novel technique for stone extraction in these challenging cases.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Cross-trigonal ureteral reimplantation for vesicoureteral reflux creates transversely oriented ureters.
- This anatomical change poses challenges for future ureteroscopic procedures.
- Patients are at increased risk for ureteral stones and urothelial cancers with age.
Observation:
- A 17-year-old male with a lower ureteral stone presented after cross-trigonal ureteral reimplantation.
- Transurethral ureteroscopy was anticipated to be difficult due to the ureter's transverse orientation.
Findings:
- A percutaneous transvesical ureteroscopy technique was successfully employed for stone extraction.
- This approach navigated the challenging ureteral anatomy effectively.
Implications:
- Percutaneous transvesical ureteroscopy is a viable alternative for managing ureteral stones in patients with prior cross-trigonal reimplantation.
- This technique expands the endoscopic options for complex ureteral stone cases.
- Further evaluation of this method in similar patient populations is warranted.
Abstract:
In the past two decades, the widespread use of cross-trigonal ureteral reimplants for the treatment of children with vesicoureteral reflux has resulted in a large population of patients with transversely lying ureters. As this population gets older they will consequently be entering an age group at higher risk for stone and urothelial cancer formation, with the potential for diagnostic and/or therapeutic ureteroscopy. The anatomic orientation of the ureters resulting from a cross-trigonal reimplantation may create difficulty or even inability to perform transurethral ureteroscopy. This case presents the technique of percutaneous transvesical ureteroscopy for stone extraction in a seventeen-year-old male with a lower ureteral stone following cross-trigonal ureteral reimplantation. The described technique may serve as an addition to the current endoscopic methods.