Assistant Professor of Radiology University of Cincinnati Medical Center
Jacob Byers: No financial relationships to disclose
James Roebker, MD, MBA: No financial relationships to disclose
Abouelmagd Makramalla, MD: No financial relationships to disclose
Ali Kord, MD, MPH: No financial relationships to disclose
To discuss clinical indications and contraindications of percutaneous endoscopy-assisted genitourinary (GU) interventions
To discuss the technical details and device settings of endoscopy-assisted procedures in native and transplantkidneys
To summarize postprocedural follow-ups after percutaneous endoscopy of the GU system
Background: There is an up-trending clinical indicationfor percutaneous endoscopy procedures operated by interventional radiologists in different organs. The utility of percutaneous endoscopy in the biliary system is relatively well studied, but there is a paucity of data on percutaneous endoscopy-assisted procedures in GU diseases. Patients with multiple comorbid conditions, or difficult anatomy who are not an optimal candidate for conventional urologic surgeries or cystoscopy can benefit from percutaneous endoscopic procedures.
Clinical Findings/Procedure Details: Emerging percutaneous endoscopy-assisted techniques provides direct visualization of the collecting system which can be combined with fluoroscopic guidance in anatomically-challenging cases. The percutaneous access to the collecting system can be utilized to accept a small caliber percutaneous endoscope over a wire and through a sheath. The percutaneous endoscopy-assisted procedures in the GU system includelithotripsy of ureteral stones not amenable to cystoscopy, ureteral lesion biopsy, recanalization of severe ureteral stenosis, and laser incision of short-segment ureteral strictures after renal transplant. Mid to upper pole access is preferable and lowers the chance of luminal injury at the ureteropelvic junction while advancing the endoscope. The potential post-procedural complications are rare and include bleeding and ureteral perforation. A safety nephrostomy or nephroureterectomy catheter is placed after percutaneous interventions which can be removed on the follow-up visits.
Conclusion and/or Teaching Points: Percutaneous endoscopyequips interventional radiologists with direct visualization and can be beneficial to treating ureteral stones and strictures and performing intraluminal biopsies. These novel percutaneous techniques offers new possibilities particularly to patients with altered anatomy or multiple comorbidities precluding surgical interventions.