Mainz pouch II (modified ureterosigmoidostomy) is an established technique for permanent
urinary diversion in patients with congenital malformations or acquired diseases of
the bladder [1]. If urolithiasis occurs, an effective and minimally invasive therapy is mandatory.
Extracorporeal shock-wave lithotripsy and surgical procedures are frequently used
treatment strategies [2]. Retrograde endoscopic management is an alternative option, which has been reported
rarely.
We report here the case of a 24-year-old man, who had undergone ureterosigmoidostomy
at the age of 12 months due to bladder exstrophy. The follow-up was unremarkable until
the patient’s current presentation with acute right flank pain. The ultrasound examination
revealed right-sided hydronephrosis, and computed tomography identified a 6-mm ureteral
calculus. During sigmoidoscopy, both ureteral ostia were located at a distance of
15 cm from the anal verge, with a normal macroscopic appearance. Urine drainage was
identified only at the proximal ostium (Figure [1]). The ”dry” distal ostium was therefore intubated using a duodenoscope with a conventional
endoscopic retrograde cholangiopancreatography (ERCP) catheter. A retrograde ureterogram
was obtained by injecting contrast medium, revealing the 6-mm concrement in the distal
ureter (Figure [2]). A Dormia basket was inserted and the calculus extracted (Figure [3]).
Figure 1 Endoscopic image of the proximal ureteral ostium, with urine draining into the Mainz
pouch II.
Figure 2 The retrograde ureterogram, obtained by injecting contrast medium after intubating
the ostium with an endoscopic retrograde cholangiopancreatography catheter, shows
the ureteral calculus.
Figure 3 Retrograde ureterogram, showing the Dormia basket in the ureter.
To our knowledge, this is the first reported case of successful extraction of a ureteral
calculus using a duodenoscope in a patient with Mainz pouch II. Fitzgerald et al.
report successful management of a ureteral calculus in a patient with ureterosigmoidostomy
by retrograde sigmoid endoscopy with a 21-Fr cystoscope, in combination with intracorporeal
lithotripsy [3]. Costamagna et al. successfully managed 19 of 24 ureteroileal complications in patients
with ileal pouches using a duodenoscope. A ureteral calculus was removed in one patient
[4].
Retrograde endoscopic management of ureteral calculi is thus a simple technique, which
is minimally invasive and provides good access to the distal ureter in patients with
ureterosigmoidostomy.
