Endourological autologous bypass-ureteroplasty for anastomotic atresia in orthotopic neobladder: a novel surgical approach and case report

Background: Ureteroenteric anastomotic stricture is a common complication after ureteral diversion with radical cystectomy, which leads to hydronephrosis, infection, and chronic renal failure. Although ureteroneocystostomy is reliable, its high degree of invasion often causes great damage and postoperative complications in patients. Therefore, we offer a new endoscopic approach with relatively limited invasion for severe obstructions such as ureteroenteric anastomotic atresia. Case Description: A 65-year-old man underwent radical cystectomy and urinary diversion of orthotopic neobladder and standardized chemotherapy for high-risk non-muscle-invasive bladder cancer. Severe left hydronephrosis was then detected due to ureteroenteric anastomotic atresia. Percutaneous nephrostomy was performed to preserve renal function. Based on our previous experience in ureteral bypass construction utilizing the Allium ureteral stent, the patient received a successful endourological autologous bypass-ureteroplasty to treat ureteroenteric anastomotic atresia in an orthotopic neobladder and maintained mild hydronephrosis with a stent-free in the follow-up. Conclusions: The case offers an innovative and promising surgical modality to overcome the limitations of the existing endourological techniques, which often require long-term placement of ureteral stents to maintain drainage and are associated with stent-related symptoms. Compared to traditional ureteroneocystostomy, endoscopic treatment offers advantages such as minimal invasiveness and fewer postoperative complications. With advancements in related techniques, endoscopic management has become a promising alternative for selected cases.