Endoscopic ultrasound-guided ureterosigmoidostomy in malignant ureteral obstruction: description of a new method

Introduction

Malignant ureteral obstruction is a late and potentially terminal complication of pelvic malignancies such as bladder, colon, and uterine cancer [1]. Traditionally, palliation of unresectable malignant obstruction takes place with percutaneous nephrostomy, endoscopic stenting, or a combination of both, which are methods known to improve renal function and quality of life [2]. Although these techniques of urinary diversion are routinely carried out by urologists, only a fraction of patients benefit from conversion to internal drainage. Unlike their counterparts of the gastrointestinal and biliary tract, palliation of malignant extrinsic compression of the ureter with endoprosthesis is often unsuccessful, with a reported failure rate of approximately 60 % [3]. We describe a new technique, endoscopic ultrasound (EUS)-guided ureterosigmoidostomy, which aimed to relieve a malignant ureteral obstruction of a poor surgical candidate in whom prior uroendoscopic stent insertion had failed.

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