Endoscopic ureteroureterostomy for a complete obstructed ureter: a case report

We report a case in which the completely obstructed ureter was successfully treated by endourological procedure. The patient was a 66-year-old male who had been admitted for panperitonitis caused by diverticulitis perforation of the sigmoid colon. About one month later, leakage of both stool and urine and left hydronephrosis were observed. Therefore, left percutaneous nephrostomy was performed and the artificial anus was created. Radiographic examination showed about 1 cm defect on the lower one-third of the left ureter. (1st Operation) A 9.5 Fr. rigid ureteroscope was inserted into the left ureter transurethrally and a 7.5 Fr. flexible ureteroscope was inserted percutaneously. Antegrade puncture using a stiff end of a 0.038-inch guidewire into the obstructed segment was failed. Then, we bit off the obliterated tissue with a biopsy forceps transurethrally towards the light from the flexible scope, and a 12 Fr. double-J stent was indwell. (2nd Operation) Eight weeks after the first operation, a 12 Fr. ureteroresectoscope was inserted transurethrally. Full-thickness cold-knife incision of the re-established ureter was failed, however. (3rd Operation) Two weeks after the second operation, a 12.5 Fr. ureteroscope was inserted transurethrally, and a full-thickness incision in the lateral position of the re-established ureter was successfully made by KTP-laser. Then, a 12 Fr. endopyelotomy stent was placed. (Result) Six weeks after the third operation, the stent was removed and DIP revealed the improvement in hydronephrosis. The patient presented no recurrence at 2-year follow up.