Use of Radiofrequency Tip Wire to Cross Ureteral Anastomotic Obstruction for Placement of Retrograde Nephroureteral Stent

1.Present a novel technique of utilizing the PowerWire^® radiofrequency wire to transverse ureteroenteric strictures in patients who have undergone creation of an illeal conduit status post cystectomy with prior failed placement of a retrograde nephroureteral stent. 2. Describing the technical aspects of this procedure. 3. Outline advantages and disadvantages of this technique.

 

Background:

Radiofrequency (RF) tip wires can be utilized in recanalization of central venous stenosis where standard practices to transverse occlusions have failed {1}. In the literature, this wire has also been utilized in urologic and non-urologic interventions such as creating a neouretercystostomy for chronic ureteral stricture or crossing post-surgical bile duct stenosis {2-4} Endoscopic procedures have been used to transverse these strictures with a 46% success rate {5). Open surgical revision has been used as a last resort for symptomatic strictures when recanalization is not feasible {6}. We propose a novel technique utilizing the PowerWire^®radiofrequency device to transverse distal ureteroenteric strictures in these patients when standard procedures have failed in order to avoid open surgical revision. 

 

Clinical Findings/Procedure Details:

In the first case, the patient developed a left ureteroenteric anastomotic stricture and a RF wire was utilized to cross this stricture and a retrograde nephroureteral stent was placed. There was a minor complication of abscess formation which resolved with percutaneous drainage. In the second case, the patient developed a left ureteroenteric stricture requiring placement of a left nephrostomy tube. During a future visit, internal stent placement with sharp recanalization was unsuccessful. A RF wire successfully crossed the stricture and a left retrograde nephroureteral stent was placed. The third case is a patient who developed bilateral ureteroenteric strictures. A internal stent was successfully placed through the left stricture. A RF wire was used to cross the right ureteral stricture and balloon dilation of the stricture was performed resulting in contrast extravasation. A 7mm x 2.5 cm Viabahn stent graft (Gore, Flagstaff, AZ) was placed across the stricture with a retrograde nephroureteral stent. The fourth case involves a ileal conduit who developed a left ureteroenteric stricture. A RF wire was utilized to cross the distal stricture and a retrograde nephroureteral stent was placed after balloon dilatation.  


Conclusion and/or Teaching Points:

The use of a radiofrequency wire is a feasible alternative for recanalization of ureteroenteric strictures after ileal conduit creation.