Endoscopic Treatment of Complete Ureterointestinal Stenosis Without Antegrade Ureteroscopy.

Abstract

Background: Ureterointestinal stenosis is a frequent complication after radical cystectomy, occurring in up to 10%-12% of cases. Endoscopic treatment of complete stenosis has been described through double access, with antegrade flexible ureteroscopy and simultaneous retrograde endoscopy through the intestinal diversion. We present a case of endoscopic treatment without use of antegrade ureteroscopy. Case Presentation: A 52-year-old man underwent surgery for peritoneal carcinomatosis secondary to mucinous adenocarcinoma. Ileocecal resection, omentectomy, sigmoidectomy, rectal resection, cystoprostatectomy, and ileal duct were performed. He had a complicated postoperative period because of enterocutaneous fistulas, peritonitis, and secondary intention wall closure, needing multiple surgeries. Four months later, he was diagnosed with left ureteroinestinal stenosis, for which endoscopic management was the chosen treatment. Intraoperative diagnosis was complete stenosis. To locate the stenosis, methylene blue was instilled using a percutaneous ureteral catheter. With a resectoscope inserted through the ileal duct, the stenosis was observed and opened using cold knife and Collins knife. The stenosis was resolved satisfactorily. Conclusion: Endoscopic management of complete ureterointestinal stenosis is a viable treatment option. Although stenosis localization has previously been described with two endoscopes using transillumination, we demonstrate another localization technique using methylene blue.