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 review article, we have summarized the relevant published literature regarding the outcomes and challenges encountered during retrograde URS in patients with UD. Materials and Methods: We conducted a systematic review of literature according to Cochrane and preferred reporting items for systematic reviews and meta-analysis guidelines for all studies reporting on retrograde URS 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 6 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 to 80% and 0 to 44% respectively, with most complications being Clavien I in nature. Conclusion: Retrograde URS can be technically challenging due to ureteric cannulation, strictures, and anatomical variations. However, there is very little evidence currently available on this topic with data based on retrospective case series. In experienced hands, it seems to be relatively successful with a low risk of major complications.

Keywords:
Urinary diversion, Retrograde, Ureteroscopy, Neobladder, Ileal conduit
1.
Nelson CP, Wolf JS Jr, Montie JE, et al: Retrograde ureteroscopy in patients with orthotopic ileal neobladder urinary diversion. J Urol 2003; 170: 107–110.
2.
Hyams ES, Winer AG, Shah O: Retrograde ureteral and renal access in patients with urinary diversion. Urology 2009; 74: 47–50.
3.
Delvecchio FC, Kuo RL, Iselin CE, et al: Combined antegrade and retrograde endoscopic approach for the management of urinary diversion-associated pathology. J Endourol 2000; 14: 251–256.
4.
Lam PN, Te CC, Wong C, et al: Percutaneous cystolithotomy of large urinary-diversion calculi using a combination of laparoscopic and endourologic techniques. J Endourol 2007; 21: 155–157.
5.
Munoz JJ, Ellison LM: Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol 2000; 164: 1523–1525.
6.
Hall MC, Koch MO, McDougal WS: Metabolic consequences of urinary diversion through intestinal segments. Urol Clin North Am 1991; 18: 725–735.
7.
Turk TM, Koleski FC, Albala DM: Incidence of urolithiasis in cystectomy patients after intestinal conduit or continent urinary diversion. World J Urol 1999; 17: 305–307.
8.
Okhunov Z, Duty B, Smith AD, et al: Management of urolithiasis in patients after urinary diversions. BJU Int 2011; 108: 330–336.
9.
Ramsey S, McIlhenny C: Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient. Spinal Cord 2011; 49: 948–954.
10.
Cohen TD, Streem SB, Lammert G: Long-term incidence and risks for recurrent stones following contemporary management of upper tract calculi in patients with a urinary diversion. J Urol 1996; 155: 62–65.
11.
Terai A, Arai Y, Kawakita M, et al: Effect of urinary intestinal diversion on urinary risk factors for urolithiasis. J Urol 1995; 153: 37–41.
12.
Tran W, Serio AM, Raj GV, et al: Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-term surveillance. J Urol 2008; 179: 96–100.
13.
Hertzig LL, Iwaszko MR, Rangel LJ, et al: Urolithiasis after ileal conduit urinary -diversion: a comparison of minimally -invasive therapies. J Urol 2013; 189: 2152–2157.
14.
Singla N, Montie JE, Lee CT, et al: Experience with 45 consecutive patients with neobladders undergoing retrograde ureteroscopy for upper tract abnormalities. Urol Pract 2015; 2: 244–249.
15.
Gerber GS, Kuznetzov D, Leef JA, et al: Holmium: YAG laser endoureterotomy in the treatment of ureteroenteric strictures following orthotopic urinary diversion. Tech Urol 1999; 5: 45–48.
16.
Rivera M, Krambeck A: Retrograde ureteroscopy via a continent urinary diversion: surgical techniques and common pitfalls. J Endourol 2014; 28: 763–766.
17.
Olson L, Satherley H, Cleaveland P, et al: Retrograde endourological management of upper urinary tract abnormalities in patients with ileal conduit urinary diversion: a dual-center experience. J Endourol 2017; 31: 841–846.
18.
Somani BK, Aboumarzouk O, Srivastava A, et al: Flexible ureterorenoscopy: tips and tricks. Urol Ann 2013; 5: 1–6.
19.
Tomaszewski JJ, Smaldone MC, Ost MC: The application of endoscopic techniques in the management of upper tract recurrence after cystectomy and urinary diversion. J Endourol 2009; 23: 1265–1272.
20.
Zhong W, Yang B, He F, et al: Surgical management of urolithiasis in patients after urinary diversion. PLoS One 2014; 9:e111371.
21.
Michel MS, Trojan L, Rassweiler JJ: Complications in percutaneous nephrolithotomy. Eur Urol 2007; 51: 899–906.
22.
Somani BK, Desai M, Traxer O, et al: Stone-free rate (SFR): a new proposal for defining levels of SFR. Urolithiasis 2014; 42: 95.
23.
Doizi S, Traxer O: Flexible ureteroscopy: technique, tips and tricks. Urolithiasis 2018; 46: 47–58.
© 2018 S. Karger AG, Basel
2018
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