Endopyelotomy sheath: a new device to facilitate antegrade endopyelotomy

PURPOSE: Antegrade endopyelotomy is still the treatment of choice in most cases of ureteropelvic junction obstruction. In this approach using the standard technique the cold knife incision invariably falls in a different plane, which may result in a thin strip of ureteral mucosa and at times avulsion as well as difficult passage of the endopyelotomy stent. A modified technique using a new device has been studied to augment safety and the precision of incision at the ureteropelvic junction during endopyelotomy. MATERIALS AND METHODS: The endopyelotomy sheath is a 22 cm. hollow polyurethane tube with a proximal size of 7 cm. that is 12Fr to 16Fr, tapering to 6Fr distally. This sheath is passed over a single guide wire and advanced under fluoroscopic guidance until the wider proximal end is placed across the ureteropelvic junction. The proximal end has a slit that is directed at the incision site and through which an incision is made with a cold knife. RESULTS: To date this modified technique has been used in 16 patients. The sheath provided good space for making an incision and made the movement of the knife safe and much easier. The incision was smooth and always made at 1 place, ensuring the preservation of the maximum circumference of the mucosa across the ureteropelvic junction. Mean function +/- SEM was 36.18% +/- 6.14% (range 27% to 48%) and mean pelvic volume was 44 ml. (range 34 to 60). At a mean followup of 10 months (range 3 to 17) 14 patients (87.5%) showed objective improvement. CONCLUSIONS: This endopyelotomy sheath simultaneously dilates the ureteropelvic junction and allows a smooth cut in a straight line at a predetermined site. By this maneuver the maximum circumference of mucosa is preserved for better healing and possibly better results. Passing the endopyelotomy stent was not a problem. This sheath makes endopyelotomy safe, easy and user friendly.     

MISSED ANTERIOR CROSSING VESSELS DURING OPEN RETROPERITONEAL PYELOPLASTY: LAPAROSCOPIC TRANSPERITONEAL DISCOVERY AND REPAIR

PURPOSE: Extrinsic ureteropelvic junction obstruction due to anterior crossing segmental renal vessels is present in more than 50% of patients in adulthood. In this situation the ureter must usually be dismembered and transposed anterior to the crossing vascular structures, where it is anastomosed to the renal pelvis. Via the open retroperitoneal approach there may be a limited view of the anterior surface of the ureteropelvic junction and, hence, anterior crossing vessels may possibly be missed. We describe 2 patients with ureteropelvic junction obstruction in whom anterior vessels were missed during open retroperitoneal repair. Laparoscopic transperitoneal secondary pyeloplasty with posterior displacement of the crossing renal vessel was performed in each case. MATERIALS AND METHODS: Two patients presented with symptomatic congenital ureteropelvic junction obstruction after failed endopyelotomy in 1 and failed open retroperitoneal procedures in both. Preoperatively spiral computerized tomography angiography with a ureteropelvic junction protocol revealed crossing vessels in the 2 cases. This finding was confirmed at transperitoneal laparoscopic pyeloplasty. The ureter and renal pelvis were transposed anterior to the crossing vessels and 2 rows of running sutures were placed to complete the anastomosis. RESULTS: The 2 laparoscopic procedures were completed successfully. The anterior crossing vessels were preserved in each case. Currently the patients are asymptomatic and furosemide washout renal scan was normal. CONCLUSIONS: Spiral CT angiography reliably delineates the renal vascular anatomy in patients with ureteropelvic junction obstruction. This study may be valuable before planned open retroperitoneal ureteropelvic junction obstruction repair. Laparoscopic pyeloplasty may successfully manage anterior crossing vessels associated with secondary ureteropelvic junction obstruction.     

Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction

PURPOSE: Laparoscopic pyeloplasty has become a viable option for the treatment of select patients with primary ureteropelvic junction obstruction with success rates similar to those of open surgery. However, little has been written on the application of this technique for secondary ureteropelvic junction obstruction. We report the largest series of secondary ureteropelvic junction obstruction managed by laparoscopic pyeloplasty. MATERIALS AND METHODS: Between March 1994 and March 2001, 36 patients underwent laparoscopic transperitoneal pyeloplasty for secondary ureteropelvic junction obstruction. The patients had undergone an average of 1.3 ureteropelvic junction procedures (range 1 to 4) prior to presentation, including cutting balloon retrograde endopyelotomy in 28, antegrade endoscopic endopyelotomy in 7, retrograde endoscopic endopyelotomy in 4, retrograde balloon dilation in 4 and open pyeloplasty in 3. A preoperative diagnosis of recurrent obstruction was confirmed by renal scan in 31 cases, retrograde pyelography in 2 and computerized tomography in 3. Of the 31 patients who underwent spiral computerized tomography angiogram 87% had crossing vessels. Laparoscopic repair comprised dismembered pyeloplasty in 31 cases, Fengerplasty in 3 and flap repair in 2. Postoperative renal scan or excretory urography objective followup was available for all patients at a mean of 10 months (range 3 to 40). Postoperative subjective patient well-being was assessed using an analog pain scale at a mean followup of 21.8 months (range 3 to 85). RESULTS: Average operative time was 6.2 hours (range 2.7 to 10). Average hospital stay was 2.9 days (range 1 to 7). One intraoperative complication occurred, that is bleeding necessitating conversion to an open procedure. Postoperative complications occurred in 8 cases, including anastomotic leakage in 4, and urinary tract infection, pneumonia, atelectasis, fever, bilateral upper extremity weakness and stone formation 2 months postoperatively in 1 each. On excretory urography, furosemide renal scan or the Whitaker test 32 of 36 patients (89%) had a widely patent ureteropelvic junction. Two patients (5.5%) had equivocal radiographic studies but were asymptomatic. In 2 patients the ureteropelvic junction was obstructed by renal scan. One patient had an indwelling stent for renal function deterioration and 1 was asymptomatic. Hence, 34 of the 36 patients (94%) had a reasonable objective response. Overall a 50% or greater decrease in pain was seen in 32 of 36 patients (89%). In the 4 patients with a less than 50% decrease in pain objective renal scans showed an open ureteropelvic junction. As such, the overall success rate of a greater than 50% decrease in pain, a patent ureteropelvic junction and stable or improved function of the affected renal unit was 83% (30 of 36 patients). CONCLUSIONS: For secondary ureteropelvic junction obstruction, laparoscopic pyeloplasty can be performed safely with a success rate comparable to that of standard open pyeloplasty. The patient benefits of laparoscopic ureteropelvic junction repair of secondary ureteropelvic junction obstruction are similar to the benefits of laparoscopic repair of primary ureteropelvic junction obstruction.     

Percutaneous endopyeloplasty: a novel technique

BACKGROUND AND PURPOSE: Despite a 10% to 15% failure rate, endopyelotomy remains the treatment of choice for most patients with ureteropelvic junction (UPJ) obstruction. We present a novel technique of percutaneous endopyeloplasty, wherein a precise, full-thickness approximation of a standard longitudinal endopyelotomy incision is performed in a horizontal Heineke-Mikulicz fashion through the conventional solitary percutaneous tract via a nephroscope. We assess the feasibility and efficacy of percutaneous endopyeloplasty in a chronic porcine bilateral UPJ obstruction model and compare outcome data with those#10; of conventional endopyelotomy and laparoscopic pyeloplasty. MATERIALS AND METHODS: Partial UPJ obstruction was created in 20 kidneys (11 pigs) by laparoscopic ligation of the upper ureter over a 5F ureteral catheter. After development of hydronephrosis over a period of 4 to 6 weeks, percutaneous endopyeloplasty (N = 10), conventional percutaneous endopyelotomy (N = 5), or laparoscopic pyeloplasty (N = 5) was performed. The essential steps of percutaneous endopyeloplasty include retrograde ureteral catheterization, standard percutaneous endopyelotomy incision, mobilization of the distal ureteral lip, horizontal suturing of the endopyelotomy incision through the nephroscope, and nephrostomy drainage and ureteral stenting. Suturing was performed using a modified 5-mm laparoscopic device (Sew Right 5 SR; LSI Solutions, Rochester, NY), which was passed through the nephroscope. RESULTS: Percutaneous endopyeloplasty was technically successful in all 10 kidneys with a mean total operative time of 81.4 minutes (range 51-117 minutes). The mean endopyeloplasty suturing time was 29.4 minutes (range 20-64 minutes). Three kidneys required two sutures, while seven kidneys required three sutures to complete the endopyeloplasty. The solitary complication was a lower-pole infundibular stenosis. Over a mean follow-up of 7.7 weeks, all renal units showed relief of obstruction, as evidenced by regression of hydronephrosis,#10; improvement in T(1/2) and glomerular filtration rate on renogram, and a low intrapelvic pressure on Whitaker test. At autopsy, the endopyeloplasty site showed a fine, well-healed transverse scar with no evidence of residual suture on the mucosal surface. The mean caliber of the UPJ following endopyeloplasty (13.8F +/- 2.2F) was significantly greater (P = 0.01) than that following endopyelotomy (7.5F +/- 1.9F). Intraoperative extravasation on completion of endopyeloplasty was absent (N = 6) or mild (N = 4) compared with that seen in all five kidneys following endopyelotomy. CONCLUSION: Percutaneous endopyeloplasty is feasible, simple, reproducible, and effective. Its advantages over conventional endopyelotomy include transrenal performance of a Fenger-plasty, wider caliber of the UPJ, absence of extravasation, and shorter duration of ureteral stenting.     

DISMEMBERED V-FLAP PYELOPLASTY

PURPOSE: We present a modified technique of pyeloplasty that seems ideally suited for reoperative as well as primary repair of ureteropelvic junction obstruction due to high ureteral insertion. MATERIALS AND METHODS: This repair combines the dismembered technique with creation of a V-flap of renal pelvis by dividing and incising through the ureteropelvic junction superolateral onto the pelvis to a height above the most dependent portion of the pelvis just exceeding the length of ureteral spatulation. The V-flap is completed by an inferolateral incision directed toward the lateral aspect of the pelvis at its most dependent portion. The tip of the V-flap is then flipped down and approximated to the apex of the posterior ureteral spatulation. Of the 12 cases managed by this procedure 2 were reoperative and 10 involved select primary repair with high ureteral insertion at the ureteropelvic junction. Patient age was 3 months to 17 years (median 11 months). Two procedures were performed via a dorsal lumbar incision in the oldest patients and 10 were done via the standard anterior extraperitoneal approach. Radiological evaluation, including mercaptoacetyltriglycine renal scan and/or excretory urography, was performed in all patients preoperatively and postoperatively. RESULTS: In all patients postoperative mercaptoacetyltriglycine renal scan and/or excretory urography at 3 months and 1 year showed excellent drainage after dismembered V-flap pyeloplasty. CONCLUSIONS: Dismembered V-flap pyeloplasty has proved to be successful with a number of advantages over the Anderson-Hynes dismembered technique in select patients. These advantages include the avoidance of tissue tension that make mobilization of the kidney and ureter unnecessary, aggressive ureteral spatulation, creation of a dependent, funneled configuration and automatic tapering of a redundant pelvis in the routine course of closure without excision of tissue. This technique also has the advantage of being simpler than other flap repairs and it combines the physiological virtues of dismembered repair with the anatomical advantages of flap pyeloplasty.     

Stented versus nonstented pediatric pyeloplasty: a modern series and review of the literature

PURPOSE: Dismembered pyeloplasty remains the principal surgical therapy for pediatric ureteropelvic junction obstruction, although the method of postoperative drainage continues to be debated. We compared stented versus nonstented repairs in a modern series. MATERIALS AND METHODS: We evaluated 117 pediatric dismembered pyeloplasties performed by 3 pediatric urologists at 2 institutions from 1991 to 2000. Hospital stay, success rate and complication rate were reviewed. Results were compared with 833 evaluable cases in the literature. RESULTS: Of the 52 stented repairs urological complications developed in 6 (12%), including symptomatic urinary tract infection in 3 and temporary obstruction in 3. Of the 65 nonstented repairs urological complications developed in 10 (15%), including prolonged leakage in 3, urinoma in 3, obstruction in 3 and urinary tract infection in 1. Mean hospitalization plus or minus standard error was shorter in the stented group (2.1 +/- 0.89 versus 2.6 +/- 1.1 days, p <0.02). We identified 9 previous studies comparing a total of 339 stented with 494 nonstented repairs. Overall the number of complications was almost equal (12% versus 14%) but the stented group had more infections, whereas more leaks occurred in the nonstented group. The nonstented group required more secondary procedures (12 of 339 versus 45 of 494, p = 0.003). Hospital stay was 12 days for stented and 5 days for nonstented repair in these earlier series. CONCLUSIONS: In children the outcome of stented pyeloplasty is similar to that of nonstented repair. In contrast to previous reports, using a stent for drainage should not necessitate a longer hospital stay.     

Ureteropelvic junction obstruction: an innovative approach combining metallic stenting and virtual endoscopy

PURPOSE: We report our experience with auto-expandable metallic stents for treating ureteropelvic junction obstruction. MATERIALS AND METHODS: We treated 4 patients with a mean age of 45 years who had ureteropelvic junction obstruction with placement of a self-expandable intraureteral metallic stent (Wallstent, Schneider, Zurich, Switzerland). All patients presented with recurrent ureteropelvic junction obstruction after open pyeloplasty. Excretory urography and 3-dimensional reconstruction computerized tomography were performed 1 and 6 months after stent insertion. Virtual endoscopy images were obtained at followup due to the need to define ureteral patency. RESULTS: Mean followup was 16 months (range 9 to 24). Wallstent placement was successful and immediate patency was achieved in all cases. During followup 3 patients required no further intervention and the stented ureteropelvic junction remained patent. In the remaining patient stricture recurred 2 months after initial stent insertion due to the ingrowth of scar tissue through the prosthesis. Additional intervention was deemed necessary after placing a longer 6 cm., completely coaxial overlapping metal stent. Virtual endoscopy and excretory urography findings concurred. Virtual endoscopy allows visualization of the stented ureteropelvic junction lumen cephalad and caudal to the prosthesis. It also enables easy navigation within the stent at different angles of view. CONCLUSIONS: The concept of applying metallic stents for ureteropelvic junction obstruction and adjacent adynamic ureteral segments combined with virtual endoscopy is strengthened by the results of this study.     

Endoureterotomy by intraluminal invagination for nonmalignant ureterointestinal anastomotic strictures: description of a new surgical technique and long-term followup

PURPOSE: We describe a new surgical endoscopic technique for nonmalignant ureterointestinal anastomotic strictures. This procedure involving endoureterotomy by intraluminal invagination (the Lovaco technique) is performed by adopting a combined percutaneous antegrade and endoscopic retrograde approach. The results obtained by this technique are reviewed with long-term followup. MATERIALS AND METHODS: A total of 25 ureterointestinal anastomotic strictures were subjected to endoureterotomy by intraluminal invagination, including 12 left, 7 right and 3 bilateral cases. Surgical success was defined by radiological improvement and/or the ability to recover normal activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes. RESULTS: At a median followup of 51 months (range 2 to 145) the success rate for endoureterotomy by intraluminal invagination was 80% (20 of 25 ureterointestinal anastomotic strictures). No complications were recorded in the patients following endoureterotomy. CONCLUSIONS: This new endoureterotomy technique for ureterointestinal strictures following urinary diversion can be applied to any type of urinary diversion. It allows direct visualization of the stricture and stricture tissue biopsy. Intraluminal invagination makes it possible to increase the distance between the stricture, and the retroperitoneal vessels and bowels. The technique provides the control required to ensure full-thickness and full-length stricture incision. The success rate is high and it persists after long-term followup.     

Laparoscopic ureterocalicostomy: initial experience

PURPOSE: Ureterocalicostomy is a reconstructive option in the rare patient with surgically failed or difficult ureteropelvic junction (UPJ) obstruction with fibrosis and significant hydronephrosis. We introduce the technique of laparoscopic ureterocalicostomy. MATERIALS AND METHODS: Laparoscopic ureterocalicostomy was performed in 2 patients, of whom 1 had UPJ obstruction and multiple secondary calculi in a dilated, dependent lower pole calix, and 1 had surgically failed UPJ obstruction with a scarred pelvis and significant hydronephrosis. Using a transperitoneal technique the UPJ was dismembered and suture ligated, the cut end of the ureter was spatulated, the attenuated lower pole renal parenchyma was amputated and mucosa-to-mucosa ureterocaliceal anastomosis was performed with running 4-zero absorbable suture over a stent. In the first case 32 renal calculi were also removed using a combination of laparoscopic nephroscopy and intraoperative ultrasonography. RESULTS: In cases 1 and 2 operative time was 5.2 and 2.5 hours, estimated blood loss was 200 and 75 cc, and hospital stay was 2 days, respectively. There were no intraoperative complications. The stent was removed at 8 and 5 weeks, respectively. Postoperative retrograde pyelogram and diuretic renal scan confirmed anastomotic patency and improved drainage in each patient. At 9 months patient 1 remains without flank symptoms and a second renal scan at 6 months showed further improvement in drainage. Patient 2, who continued to be symptomatic with flank discomfort despite objective improvement in drainage parameters, elected secondary nephrectomy at 6 months. CONCLUSIONS: Laparoscopic ureterocalicostomy is feasible and it effectively duplicates established open surgical principles. To our knowledge the initial experience in the literature is presented.     

Regional expression of inducible nitric oxide synthase in the kidney in dogs with unilateral ureteral obstruction

PURPOSE: In the early stage of unilateral ureteral obstruction total renal blood flow increases but medullary blood flow decreases, exacerbating medullary tissue hypoxia. We examined the expression of inducible nitric oxide synthase, a product of a hypoxia sensitive gene, in the cortex and medulla in dogs with unilateral ureteral obstruction for 21 hours. MATERIALS AND METHODS: Hemodynamic and clearance experiments were performed after release of ureteral obstruction in 6 dogs with unilateral ureteral obstruction, followed by Western blot analysis of nitric oxide synthase and immunohistochemistry. RESULTS: Ureteral obstruction raised mean ureteral pressure plus or minus standard error to 35.0 +/- 7.2 mm. Hg. In dogs with unilateral ureteral obstruction mean renal blood flow was 116 +/- 10 ml. per minute, lower than the 213 +/- 22 ml. per minute in sham operated dogs (p <0.01). After unilateral ureteral obstruction release the mean glomerular filtration rate was 9.5 +/- 2.1 ml. per minute, lower than the 27.3 +/- 1.8 ml. per minute in the contralateral unobstructed kidney (p <0.01). Western blot analysis showed that mean nitric oxide synthase/beta-actin in the cortex of the obstructed kidney was 0.04 +/- 0.01 densitometry units, lower than 0.11 +/- 0.02 densitometry units in the unobstructed contralateral kidney (p <0.05). In contrast, mean nitric oxide synthase/beta-actin in the medulla of the obstructed kidney was 1.29 +/- 0.33 densitometry units, greater than the 0.34 +/- 0.03 densitometry units in the unobstructed kidney (p <0.05). Immunohistochemistry revealed that the increased expression of nitric oxide synthase protein was localized to the endothelium of the vasa recta. CONCLUSIONS: Unilateral ureteral obstruction enhances nitric oxide synthase expression in the medulla but not in the cortex. This increased expression in the medulla may be the result of increased medullary hypoxia in unilateral ureteral obstruction, possibly contributing to medullary hyperemia after unilateral ureteral obstruction release.     

Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr

PURPOSE: Flexible ureteroscopes smaller than 9Fr are widely used in endourology. We systematically evaluated the functional durability of these instruments in the clinical setting. MATERIALS AND METHODS: We performed ureteronephroscopy 92 consecutive times in 84 patients at our hospital using a flexible Storz model 11274AA,double dagger Circon-ACMI model AUR-7, section sign Wolf model 7325.172 parallel and Olympus model URF/P3 ureteroscope paragraph sign. Preoperatively and postoperatively we evaluated all flexible ureteroscopes for luminosity, irrigant flow at 100 mm. Hg, number of broken image fibers and active deflection range. During the procedure a record was kept of the duration that the endoscope remained in the urinary tract, average irrigation pressure, method of insertion, various devices used within the working channel, need for lower pole access, and surgeon overall impression of visibility and maneuverability. RESULTS: The luminosity and irrigant flow of all endoscopes remained relatively unchanged during consecutive applications, while active deflection deteriorated 2% to 28%. Endoscopes were used for an average of 3 to 13 hours before they needed repair. The most fragile part of these instruments was the deflection unit. CONCLUSIONS: Small diameter flexible ureteroscopes are effective for diagnosing and treating upper urinary tract pathology but improved durability is required. Currently they represent a highly effective but high maintenance means of achieving retrograde access to the ureter and kidney with a need for repair after only 6 to 15 uses.     

Late ureteral obstruction after kidney transplantation

Abstract Today, the incidence of urological complications following renal transplantation is 2 %-10 %. Most of these complications occur within the 1st year and affect the distal ureter. We report on two patients who developed very late ureteral obstruction, 14 and 18 years after transplantation. Both patients had rejection episodes 1 and 10 months prior to the ureteral stenosis. Histological examination of one resected ureter revealed findings strongly suggestive of a rejection process. Open surgery with antirefluxive reimplantation into the bladder was successful in both patients, with a postoperative observation time of 20 and 8 months, respectively. We conclude that a percutaneous nephrostomy may be required in patients with rising creatinine and incipient hydronephrosis even long after transplantation has been performed.     

Nickel-titanium shape memory alloy Memokath 051 ureteral stent for managing long-term ureteral obstruction: 4-year experience

PURPOSE: We present our 4-year experience with the thermo-expandable shape memory alloy Memokath 051 stent (Engineers and Doctors of Copenhagen, Copenhagen, Denmark) for managing long-term ureteral obstruction. MATERIALS AND METHODS: We used a nickel-titanium shape memory alloy ureteral stent to treat 28 patients 29 to 86 years old (mean age 59.2). Ureteral obstruction was caused by malignancy in 18 cases and by recurrent benign disease in 10. A total of 37 stents were inserted from November 1996 to November 2000 using general anesthesia. Mean followup was 19.3 months (range 3 to 35). RESULTS: Upper tract decompression was achieved in all cases. Currently 15 stents are functional in 13 patients, while 8 patients died with a total of 13 functioning stents in place. In 7 patients 9 stents were removed for various reasons. There has been no radiological evidence of encrustation to date. No patient has been rehospitalized with stent related sepsis pain or hematuria, resulting in improved quality of life. CONCLUSIONS: This stent seems to provide a significant benefit over conventional Double-J (Medical Engineering Corp., New York, New York) and other metallic stents. Its remarkable thermal memory permits removal, a feature that until recently was not available in any other metallic ureteral stent. Durable and complication-free decompression of the upper tract can be achieved with the Memokath 051.     

Cut-to-the-light technique and potassium titanyl phosphate laser ureterotomy for complete ureteral obstruction

We describe a case of complete ureteral obstruction managed by endoscopic recanalization using a 'cut-to-the-light' technique followed by potassium titanyl phosphate (KTP) laser ureterotomy. A 53-year-old man developed a ureteral obstruction following the transurethral resection of a bladder tumor (TUR-Bt) at the left ureteral orifice. The length of the obstructed segment was estimated at 1 cm based on combined antegrade and retrograde contrast studies. Histopathological analysis indicated that the obstruction was caused by fibrosis. The 'cut-to-the-light' technique was used for recanalization, and KTP laser ureterotomy was performed to obtain an adequate ureteral lumen. A 14 F/7 F endoureterotomy stent was removed 6 weeks after the operation. No significant complications and no signs of stenosis were observed 24 months after endoscopic repair. Endoscopic recanalization is a safe, effective technique for the management of a completely obliterated ureteral segment, especially in combination with subsequent KTP laser ureterotomy.     

LONG-TERM RESULTS OF THE TREATMENT OF COMPLETE DISTAL URETERAL STENOSIS USING A CUTTING BALLOON CATHETER DEVICE

PURPOSE: We evaluated the long-term efficacy of endoscopic treatment of complete distal ureteral stenosis using a cutting balloon catheter. MATERIALS AND METHODS: We performed a total of 10 procedures in 9 patients with complete distal ureteral stenosis at or near the ureterovesical junction. Depending on presenting anatomy cases were treated with a retrograde only (6), antegrade only (1) or combined antegrade and retrograde (3) endoscopic technique. RESULTS: At a mean followup of 36 months (range 24 to 43) 9 of the 10 procedures (90%) were successful. Stenosis recurred in 1 of the 9 patients (10%) but a repeat procedure was successful. There were no intraoperative complications and no procedures required open surgical conversion. Although all patients noticed a various degree of hematuria postoperatively, none required blood transfusion or further intervention. Mean hospitalization was 1.1 days. CONCLUSIONS: Endoscopic repair of distal ureteral stenosis using a cutting balloon catheter is a viable option in patients with complete ureteral obstruction. This technique results in low morbidity, a short hospital stay and excellent long-term patency. Endoscopic treatment using a cutting balloon catheter may be a therapeutic option in many patients with complete distal ureteral obstruction at or near the ureterovesical junction.