ENDOSCOPIC MANAGEMENT OF TOTAL URETERAL OCCLUSION AND URETEROVAGINAL FISTULA

Between August 1991 and June 1994, endoureterotomy was performed in ni ne patients for total ureteral occlusion. Four of these patients had a n associated ureterovaginal fistula. The total ureteral occlusions wer e iatrogenic in eight patients and the result of trauma in one. The pr one split leg position was used to facilitate simultaneous antegrade a nd retrograde ureteroscopy in all nine patients. The ''cut-to-the-ligh t'' technique was utilized in six patients and a new technique employi ng a fascial incising needle was used in five patients. Five patients developed ureteral strictures within 5 months of the primary procedure that were corrected endoscopically. With a mean follow-up of 22 month s, all nine patients have a successful outcome. Endoscopic management of difficult urteral disease such as total urteral occlusion and urete rovaginal fistual is a useful alternative to open surgery.