Effective Management of Transuretero-Ureterocutaneostomy (TUUC)-Related Stenosis Using a Combined Antegrade and Retrograde Approach With Holmium Laser Endoureterotomy: A Case Report

TL;DR

A combined antegrade and retrograde approach using a holmium laser successfully treated a complication after bladder cancer surgery.

Contribution

This case report introduces a combined antegrade-retrograde holmium laser technique for managing TUUC-related stenosis.

Findings

The dual-access holmium laser endoureterotomy effectively relieved anastomotic stenosis.

The patient experienced significant symptom relief and improved renal function post-procedure.

Abstract

Bladder cancer (BC) is the seventh most common cancer globally, with significant morbidity and mortality. Radical cystectomy is the primary treatment for muscle-invasive bladder cancer (MIBC), often followed by urinary diversion techniques such as transuretero-ureterocutaneostomy (TUUC). While TUUC can be an effective alternative to urinary diversions, it is associated with complications, including anastomotic stenosis. A 60-year-old male with BC underwent radical cystectomy followed by TUUC. Postoperatively, the patient developed anastomotic stenosis, initially managed with stent placement. However, left flank pain and oliguria persisted, and imaging revealed grade 2 left hydronephrosis and elevated creatinine levels. Two operators performed the procedure, using antegrade access percutaneously as a guiding approach and retrograde access through the TUUC orifice to perform the holmium laser endoureterotomy. The holmium laser endoureterotomy was successfully performed using a dual-access technique, combining both antegrade and retrograde approaches to enhance precision and minimize tissue damage. Post-procedure, the patient experienced significant relief from symptoms, and renal function improved markedly, with decreased creatinine levels. This case underscores the effectiveness of a combined approach of holmium laser endoureterotomy in managing TUUC-related stenosis. It offers a minimally invasive solution for maintaining patency and enhancing patient outcomes after complex urinary diversion procedures.

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