Retrograde ureteroscopic manipulation in patients with ileal conduit urinary diversion is challenging but achievable
Author(s):
Miss Louise Olson
,
Miss Louise Olson
Affiliations:
Mr Hywel Satherley
,
Mr Hywel Satherley
Affiliations:
Mr Paul Cleaveland
,
Mr Paul Cleaveland
Affiliations:
Mr Bachar Zelhof
,
Mr Bachar Zelhof
Affiliations:
Mr Max Mokete
,
Mr Max Mokete
Affiliations:
Mr Donald Neilson
,
Mr Donald Neilson
Affiliations:
Mr Shalom Srirangam
Mr Shalom Srirangam
Affiliations:
BAUS ePoster online library. Olson L. 06/26/17; 177349; P2-3 Disclosure(s): None
Louise Olson
Louise Olson
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Abstract
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Introduction
The reconstructed upper urinary tract poses challenges for retrograde flexible ureteroscopy (fURS) access. We describe our dual centre experience in performing retrograde fURS in patients with ileal conduit urinary diversions (ICUD).

Methods
A retrospective analysis of all consecutive patients with ICUD who underwent retrograde fURS procedure in our institutions over a 9-year period up to August 2016 was performed.

Results
Fifty-two procedures were performed in 36 patients. Mean age was 61 (28-90) years. Average time from diversion to fURS procedure was 13.0 (0.08-53) years. Stone disease was the most common indication for intervention in 34.6% (19/54) of cases with a stone free rate of 78.9% (15/19). Other indications included tumour management in 22.2% (12/54), haematuria/abnormality on imaging 20.4% (11/54), stricture disease 11.4% (6/54), encrusted/migrated stent 7.4% (4/54). Successful retrograde access was possible in 75.5% (40/53). A long and tortuous ileal segment, too difficult to negotiate, was the most common cause of failure to access. In 14/54 (25.9%), retrograde fURS was combined with simultaneous percutaneous antegrade access. Seven (12.9%) developed post-procedural pyrexia requiring additional antibiotic therapy. Median length of stay (LOS) was 1 day (0-55) with 13 (24%) being performed as day-case procedures. Median LOS for those with fURS only was 1(0-14) days compared to those who underwent simultaneous percutaneous antegrade access at 3.5 (1-55) days.

Conclusions
To our knowledge, this is the largest reported cohort of patients undergoing retrograde fURS via ICUD. Our experience demonstrates that this is technically challenging, but a high success rate with a low morbidity is achievable in experienced centres with access to standard endo-urology equipment.
Introduction
The reconstructed upper urinary tract poses challenges for retrograde flexible ureteroscopy (fURS) access. We describe our dual centre experience in performing retrograde fURS in patients with ileal conduit urinary diversions (ICUD).

Methods
A retrospective analysis of all consecutive patients with ICUD who underwent retrograde fURS procedure in our institutions over a 9-year period up to August 2016 was performed.

Results
Fifty-two procedures were performed in 36 patients. Mean age was 61 (28-90) years. Average time from diversion to fURS procedure was 13.0 (0.08-53) years. Stone disease was the most common indication for intervention in 34.6% (19/54) of cases with a stone free rate of 78.9% (15/19). Other indications included tumour management in 22.2% (12/54), haematuria/abnormality on imaging 20.4% (11/54), stricture disease 11.4% (6/54), encrusted/migrated stent 7.4% (4/54). Successful retrograde access was possible in 75.5% (40/53). A long and tortuous ileal segment, too difficult to negotiate, was the most common cause of failure to access. In 14/54 (25.9%), retrograde fURS was combined with simultaneous percutaneous antegrade access. Seven (12.9%) developed post-procedural pyrexia requiring additional antibiotic therapy. Median length of stay (LOS) was 1 day (0-55) with 13 (24%) being performed as day-case procedures. Median LOS for those with fURS only was 1(0-14) days compared to those who underwent simultaneous percutaneous antegrade access at 3.5 (1-55) days.

Conclusions
To our knowledge, this is the largest reported cohort of patients undergoing retrograde fURS via ICUD. Our experience demonstrates that this is technically challenging, but a high success rate with a low morbidity is achievable in experienced centres with access to standard endo-urology equipment.
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