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A reliable method for simplifying flexible uretero‐renoscopy in patients with urinary diversions
Author(s) -
ELMES M.R.,
LAWRENTSCHUK N.,
BOLTON D.M.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06085_40.x
Subject(s) - medicine , urinary diversion , upper urinary tract , surgery , ureter , urinary system , lumen (anatomy) , percutaneous , complication , transitional cell carcinoma , urology , cystectomy , bladder cancer , cancer
Access to the upper urinary tract to exclude or treat recurrent transitional cell carcinoma (TCC) is not infrequently required in patients who have previously undergone urinary diversion in the management of invasive bladder carcinoma. This can be a technically difficult procedure. We describe a method which simplifies the diagnosis and treatment of upper tract TCC posturinary diversion. Patients and Methods: Four patients who had previously required urinary diversion (3 ileal conduit, 1 ileal neobladder) underwent flexible uretero‐renoscopy after antegrade skinny‐needle renal puncture and placement of a guidewire down the ureter into the ileal conduit. The guidewire is then externalised. A second guidewire is placed in a retrograde fashion using a double lumen catheter or an exchange guidewire set, and this second guidewire is then used as a guide for insertion of the flexible ureteroscope. This guidewire may be replaced repeatedly during the procedure to facilitate multiple biopsies. Results: All patients were treated successfully and without complication from placement of the percutaneous guidewire. Operating time was under one hour in all cases. Conclusions: Flexible uretero‐renoscopy of the upper urinary tract postileal urinary diversion can be made easier and less time consuming by preliminary placement of a percutaneous antegrade guidewire.