Application Of Anterograde Flexibie Ureteroscope In The Treatment Of Ureteral Obstruction After Bricker Urinary Diversion

Objective:To evaluate the clinical efficacy and safety of application of anterograde flexible ureteroscope with holmium laser and balloon dilatation in the treatment of ureteral obstruction after Bricker urinary diversion.Methods:From October2010to September2013,5patients in our hostipal with ureterointestinal anastomotic strictures after Bricker urinary diversion procedure were enrolled in this study. The average age of the patients was64years old (57～77). The first clinical presentation was averagely66months (8-168) after the Bricker urinary diversion procedure. There were3cases with single side stricture(2cases with left side strictures and1case with right side one),1case with both sides strictures,1case with right side ureterblocksystem. The urinary tract B ultrasound, CT,KUB+IVP and antegrade urography were carried out to identify the obstructive portion,lengthand,number of calculi. First, all patients underwent percutaneous nephrostomy (PCN) with F8-F12nephrostomy tube, second, expanded by fascial dilators to F14-F16, then inside incision by Holmium laser and balloon dilatation under anterograde flexible ureteroscopy and lithotripsy (with calculi). F6double J ureteral stent was indwelled for8weeks, check renal function and calculi regularly after removal of double J ureteral stents.Results:All cases were successful to treating ureterointestinal anastomotic strictures (with calculi) and double J ureteral stent were indwelled. after3-18months,renal function of all cases were normal,3cases with non-uronephrosis,1case with slight uronephrosis,1case replaced double J ureteral stent per3months for recurrent stricture. The mean operative time was95min,The blood loss was5～20mL,The mean hospital stay after operation was2.5days,. The average follow-up time was9months (3-18).Conclusion:Anterograde flexible ureteroscopy with holmium laser and balloon dilatation is an effective, reproducible and minimally invasive method for therapy for ureteral obstruction in Patients after bricker urinary diversion.