Antegrade and Retrograde IntraRenal surgery (AIRS + RIRS) for ureter stricture.

A 42-year-old male patients with gross hematuria.

2016.05.23 CT urolithiasis:

1. a stone (ac. 12mm) at left proximal ureter with severe hydronephrosis and marked parenchymal atrophy, c/w long-standing obstructive nephropathy.

No remarkable finding in RK

Stricture segment:

1.8 cm. Another surgeon failed to perform a retrograde ureteroscopic stricture incision due to the severe edema and no visualization of the stone.

** Video clips and explanation

0:00 – 13:58: AIRS should be aimed for the stone and the upper side from the guidewire. During this procedure, we can shorten the stricture segment. Then we put the ureteral catheter into the ureter to inject indigocarmine and contrast dye.

13:59 – 17:13: Flexible ureteroscopy is a better option for the ureteral wall incision than the semirigid one because we can naturally trace the ureter course. Both ends of the flexible ureteroscope and the ureteral catheter met each other at the upper margin of the stricture segment.

17: 14 – 24:44: Trimming of the inner lumen of the ureter to guarantee the maximum diameter.

24:45 – 25:55: Push the ureteral stent downward to the bladder. Insert the superstiff guidewire and a DJ ureteral stent.

Postoperative KUB