Reduction of Minor Degree Avulsion of the Distal Ureter

[Male 59-year-old] # Right flank pain -> 2016.6 local visit. # Right prox ureter stone detected, s/p ESWL (x2), but they were ESWL-resistant stones.

# Distal ureter avulsion occurred during the fragmented stone extraction during ureteroscopy. Additionally, a ureteral injury occurred and the ureter seemed to be obstructed by stricture. The patient was referred to the Seoul National University Boramae Medical Center.

Distal ureteral stricture was diagnosed and the segment seemed to be > 3-4cm. The surgical plan was:

(1) Regrograde approach for balloon diltation

(2) Antegrade approach for PASS(or AIRS)

(3) the ureteroneocystostomy.

Bladder stone removal was done first. The distal ureter became movable after the lithotripsy and the avulsion (retracted ureteral wall) was moved to its original place into the ureter lumen.

Retrograde access failed due to the poor visual field induced by the previous ureteral injury. Any contrast dye or a terumo GW could not be inserted into the kidney. We tried antegrade access. It was successful and a through-and-through ureteral catheter was inserted.

Finally, the balloon dilatation was successful and the large caliber DJ catheter could be inserted.