Category: Other, Miscellaneous

VS8-11 - Endoscopic Fluoroscopic puncture of the proximal ureter for recanalization of the ureteropelvic junction

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

we present a video of a new fluoroscopic endoscopic technique for the recanalization of the complete obstruction of the Uretero-pelvic junction (UPJ), using a puncture of the proximal ureter through the renal-pelvic wall, via the Amplatz sheath.

Methods :

3 patients (36 to 62 years-old) with a history of open pyelolithotomy, presented large hydronephrosis. Retrograde uretero-pyelography showed a complete obstruction of the UPJ.

In 2 patients the stenosis was about 2 cm, and 1 patient had a stenosis of few millimeters. The institution Ethical Committee approved the technique.

Under general anesthesia, the patients are placed in the split-leg modified lateral position. After, calyx puncture and dilation, a 24 F Amplatz sheath is placed. The inspection of the pelvic wall does not find the UPJ or its scar. A ureteral catheter is placed in the ureter and contrast media is injected. Under fluoroscopy, the Amplatz sheath is placed in front of the tip of the ureter and the ureteral catheter tip. The 18-Gauge needle is introduced via the Amplatz sheath. The proximal urteral tip is punctured through the renal pelvis wall. A hydrophilic guidewire is advanced down the ureter. Endopyelotomy is performed with an electrode through the nephroscope.

In the long strictures, A 3.5 needle-holder is inserted in the nephroscope and using a 13-mm needle suture, sutures are placed between the pelvic and the ureteral wall. Then, 1 or 2 double-J-stents are placed. Follow up is performed using retrograde pyelography and/or ureteroscopy. If the UPJ is wide open the J-stent is removed. If the UPJ patency is equivocal, balloon dilation is performed and a double-J stent is placed.

Results :

The puncture of the ureteral end through the renal-pelvic wall was rapidly and easily performed, like calyx puncture. It had allowed guidewire insertion into the ureter, and had oriented the endopyelotomy and recanalization. The suturing was difficult due to fibrosis and the tissue edges were fixed far apart. The mean operative time was 154 minutes for the 2 cases in which the UPJ was sutured, and 35 minutes for the other. The mean postoperative hospital stay was 3 days.

Control in 1 patient with the long stenosis showed a medium patent UPJ, and a new JJ-stent was placed, with a follow up of 52 months. For the other patients, the JJ-sent was removed at 3 months and 40 months, and the kidney is not dilated with a follow up of 20 and 46 months respectively.

Conclusions :

The puncture of the ureteral end through the renal-pelvic wall was possible, and it was easily performed. It had allowed insertion of at least of replaceable double-J-stent in complete stenosis, where all the other endoscopic techniques had failed, especially, in long UPJ stenosis.

Mohammed Lezrek

Professor of Urology
1- Department of Urology, Military Hospital Moulay Ismail, Meknes, Morocco. 2- Department of Urology, Al Ghassani Hospital, Fes, Morocco.
Meknes, Meknes-Tafilalet, Morocco

Dr. Mohammed Lezrek, M.D, Professor of Urology, Faculty of Medicine, University Mohamed V, Rabat Morocco. Certified Moroccan board of Urology 1999. Fellowship-Post-Residency in the Department of urology and Transplantation Edouard Herriot hospital, Lyon, France May 2001- May 2002. AFSA diploma of urology, at the university Claude Bernard Lyon, France May 2001-December 2001.
Co-chairman of the department of urology in the military Hospital Moulay Ismail, Meknes, Morocco, since 1996, and then Chairman from March 2009 to March 2011. Voluntary work Promoting endourology and minimally invasive surgery in Morocco coaching young urologist in Morocco since February 2011 to present. Charmain of the Symposium of Affordable New technologies in Urology (SANTU) since 2017.
Member of AMU (Moroccan Association of urology) since 1996, EAU 2009, SIU 2011, and Endourological society 2012.
Associate Editor and Editorial Review Board, Clinical Urology (J of AMU), since 2009.
Reviewer in the Journal of Endourology. Meeting Scientific comity: AMU meetings since 2007; SIU: 2010, 2012, 2014-2016.
Awards and Achievements: - Best video Award of AMU Congress Skhirat 2016.
- Merit Award of AMU Rabat 2015. The SIU’s Best Video Award: First Prize during the 34th Congress of the SIU Glasgow 2014. The Best Video Award: First Place, during the 3rd SANTU organized SIU Glasgow 2014. SIU’s Best video Award: runner-up video, at the 33rd Congress SIU Vancouver 2013. Best Moderated Poster Award at 2nd Symposium on SANTU during SIU Vancouver 2013.
Presented multiple videos, Moderated Posters, Unmoderated Posters, presentations, invited talk, in national and international meetings.
More than 120 videos of tips and trick of Endourology in Youtube channel:

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