Category: Clinical Stones: Outcomes

MP8-10 - Challenges of retrograde ureteroscopy (URS) in patients with urinary diversion: Outcomes from a systematic review of literature

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Introduction: Retrograde ureteroscopy (URS) can be safely and successfully performed in patients who have had previous urinary diversion (UD). With broadening indications and advances in technology, URS can be used in complex cases. In this systematic review, we have summarized the relevant published literature regarding the outcomes and challenges encountered during retrograde URS in patients with UD.

Methods :

We conducted a systematic review of literature according to Cochrane and PRISMA guidelines for all studies reporting on retrograde ureteroscopy from inception to September 2017. A literature search was conducted through MEDLINE, EMBASE, CINAHL and Cochrane library for all English language articles.

Results :

Our literature search identified six retrospective studies. In total, 125 patients with a mean age of 67 years (range: 28-90 years) underwent retrograde URS (190 procedures) after UD for diagnostic and therapeutic purposes. The main indications included upper urinary tract filling defects (due to either intrinsic pathology or extrinsic compression), strictures due to ureteral thickening, stone disease and surveillance for suspected malignancy. The success rate and complications across the studies varied from 56%-80% and 0-44% respectively, with most complications being Clavien I in nature.

Conclusions : Retrograde URS can be technically challenging due to ureteric cannulation, strictures and anatomical variations. However in experienced hands it can be relatively successful with a low risk of major complications.

Meghana N. Ramachandra

Core surgical trainee
University Hospital Southampton, UK
PORTSMOUTH, England, United Kingdom

Bhaskar K. Somani

Consultant Urologist, Associate Professor
University Hospital Southampton , U.K
Southampton, England, United Kingdom

Bhaskar is an Endourologist and Associate Professor in Southampton, and is an active member of European School of Urology 'Training and Research group' and ESUT Endourology group. He has been teaching on EUREP hands-on-training for the last 5 years and is the senior author in the new ‘Endoscopic stone treatment (EST)’ curriculum established for training and examinations. He has performed live surgery in EAU with presentations and moderations in EULIS, WCE and SIU. He is also a member of EAU ‘Train the Trainer’ committee.

He is research active and has published more than 200 papers with over 300 published abstracts/presentations. He is on the editorial board of 3 journals, a reviewer for 14 journals and Investigator for 5 trials. He sits on the MCQ panel for FRCS examinations and is a ‘Specialist advisor’ to National Institute of Clinical Excellence (NICE) Interventional procedures and ‘Invited expert’ to NICE urological infections. He is an elected member of BAUS Academic section and was recently selected as a Fellow of Faculty of Surgical Trainers.