Fluoroscopically guided pyeloureteral interventions by using a perurethral transvesical approach

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Abstract
Using a perurethral transvesical approach, we attempted a total of 180 varied pyeloureteral uroradiologic interventional procedures during a 20-month period; 168 were successfully accomplished (93% success rate). We used standard interventional equipment, fluoroscopy, and (for access to the upper urinary tract) ureteral catheters that had been partially or completely inserted at cystoscopy by urologists. The successful procedures included insertion of double-pigtail ureteral stents (42 procedures), insertion of single-pigtail ureteral stents (47), advancement of arrested or incompletely inserted retrograde ureteral catheters (42), urothelial biopsy (30), balloon dilatation of ureteral strictures (three), retrograde cannulation of ureteropelvic junction obstructions that could not be negotiated in a percutaneous antegrade fashion (three), and ureteral stone extraction (one). The method was unsuccessful in 12 patients. Failures were due to caudal migration of a ureteral catheter into the bladder in eight patients and to an inability to advance a guidewire beyond an area of ureteral obstruction or perforation in four. Although most commonly used as an adjunct to extracorporeal shock-wave lithotripsy of renal and proximal ureteral calculi, the perurethral approach was extremely valuable for a wide variety of other indications. Significant complications, encountered in 5% of the procedures, included urosepsis (two), ureteral perforations (five), and cannulation of a false ureteral lumen (two). These problems resolved without sequelae with conservative management. The perurethral transvesical approach represents a relatively simple, safe, and expeditious interventional uroradiologic method. It frequently obviated other more invasive interventions such as percutaneous nephrostomy, ureteroscopy, or surgery.