Cystoscopic Extraction Technique and External Drainage Rescue of a Failed Attempt to Traverse a Severe Transplanted Ureteral Obstruction

PURPOSE: The aim of this research was to evaluate the efficacy of the cystoscopic extraction and external drainage techniques for unsuccessful antegrade stenting in transplanted severe ureteral obstruction. MATERIALS AND METHODS: A total of 26 patients with severe transplanted ureteral obstruction in whom the cystoscopic extraction technique and/or external drainage technique was performed were retrospectively evaluated. After the severe obstruction was successfully traversed, balloon dilatation followed by double-J stent insertion was performed. RESULTS: Of the 26 patients (male:female, 9:4; mean age, 38.1 years) who underwent failed ureteral stenting with the conventional procedure, 16 patients underwent successful stenting with the cystoscopic extraction technique, and 10 patients underwent successful stenting following external drainage. The mean serum creatinine of the 26 patients before stenting was 42.9 mg/dL (range, 32.7 to 54.1 mg/dL), which decreased to 10.3 mg/dL (range, 8.7 to 11.8 mg/dL) after stenting. The complications of the procedure were lower abdominal pain in 22 patients and gross hematuria in 9 patients. All complications were relieved with medical care within 3 to 5 days after the procedure. No major complications occurred. CONCLUSIONS: The cystoscopic extraction technique and external drainage technique are safe and useful for traversing a severe transplanted ureteral obstruction after a failed conventional procedure.