PASS (Percu Antegrade Stricture Surgery)

A 62-year-old male patient underwent RIRS for removal of left renal stones (LT UPJ stone (15x13x12mm) & LKLAnt stone (13x13x10, 7x5x5, 7x5x5)) on Dec. 6, 2013. They were uric acid stones and there was no problem until 12 months after the operation.

However, incomplete stricture in the left ureter was identified on a follow-up CT at postoperative 18 months and a ureteral balloon dilatation was planned for July 2015. Unfortunately, patient cancelled the surgery due to the MERS (Middle East respiratory syndrome) outbreak in South Korea.

Recently, the patient visited my hospital again but the stricture was aggravated into the complete type in the multiple areas (L2 vertebral body midportion, 7mm-length complete stricture and some incomplete strictures in the midureter).

Open or laparoscopic resection and anastomosis is possible but we can consider the more helpful option of the antegrade approach through an upper or midpole puncture plus simultaneous retrograde approach is helpful.