Wallis M Chad, Brown David H, Jayanthi Venkata R, Koff Stephen A
Section of Urology, Columbus Children's Hospital, Ohio 43205, USA.
J Urol. 2003 Oct;170(4 Pt 2):1664-6; discussion 1666. doi: 10.1097/01.ju.0000087280.31954.35.
A criticism of the Cohen cross-trigonal reimplantation is the potential difficulty of retrograde access to the ureter. With the advent of modern endourological equipment, we devised a novel technique that obviates the aforementioned difficulty and permits even retrograde ureteroscopy.
Cystoscopy is performed and a curved tip vascular access catheter is directed towards the ureteral orifice. An angle tipped glide wire with a torque device attached is passed through the catheter and directed into the orifice. The combination of the curved catheter and angled glide wire permits passage of the wire in an axis perpendicular to that of the cystoscope. Once the glide wire has been passed into the proximal ureter it is exchanged for a super stiff guide wire. The latter literally straightens the ureter permitting direct retrograde passage of a catheter, stent or rigid ureteroscope.
This technique was successful in 6 children. Of the patients 4 underwent retrograde ureteroscopy with stone extraction, 1 underwent retrograde studies followed by stent insertion and 1 underwent retrograde catheterization alone for radiographic studies.
It is distinctly uncommon to have to access a ureter in a retrograde fashion after cross-trigonal reimplantation. However, when required the technique described reliably permits retrograde access and should dispel fears of long-term consequences of the Cohen ureteral reimplantation.
科恩（Cohen）三角交叉再植术的一个弊端是逆行进入输尿管可能存在困难。随着现代腔内泌尿外科设备的出现，我们设计了一种新技术，该技术可避免上述困难，甚至能实现逆行输尿管镜检查。
进行膀胱镜检查，将一根弯曲尖端的血管通路导管指向输尿管口。将一根带有扭矩装置的成角尖端导丝穿过导管并导入输尿管口。弯曲的导管和成角的导丝相结合，使导丝能够在与膀胱镜轴线垂直的轴线上通过。一旦导丝进入近端输尿管，就将其换成超硬导丝。后者实际上使输尿管变直，从而允许导管、支架或硬性输尿管镜直接逆行通过。
该技术在6名儿童中取得成功。其中4例患者进行了逆行输尿管镜检查并取石，1例患者先进行逆行检查，然后置入支架，1例患者仅进行逆行插管以进行影像学检查。
三角交叉再植术后逆行进入输尿管的情况极为罕见。然而，在需要时，所描述的技术能够可靠地实现逆行进入，并且应该消除对科恩输尿管再植术长期后果的担忧。
