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Case Reports
. 2025 Jun 23;17(6):e86594.
doi: 10.7759/cureus.86594. eCollection 2025 Jun.

Effective Management of Transuretero-Ureterocutaneostomy (TUUC)-Related Stenosis Using a Combined Antegrade and Retrograde Approach With Holmium Laser Endoureterotomy: A Case Report

Indrawarman Soerohardjo  1 , Ahmad Zulfan Hendri  1 , Ahmad Shafwan Natsir  1 , Narpati Wesa Pikatan  1 , Toni Febriyanto  1
Affiliations
Case Reports

Effective Management of Transuretero-Ureterocutaneostomy (TUUC)-Related Stenosis Using a Combined Antegrade and Retrograde Approach With Holmium Laser Endoureterotomy: A Case Report

Indrawarman Soerohardjo et al. Cureus. .

Abstract

Bladder cancer (BC) is the seventh most common cancer globally, with significant morbidity and mortality. Radical cystectomy is the primary treatment for muscle-invasive bladder cancer (MIBC), often followed by urinary diversion techniques such as transuretero-ureterocutaneostomy (TUUC). While TUUC can be an effective alternative to urinary diversions, it is associated with complications, including anastomotic stenosis. A 60-year-old male with BC underwent radical cystectomy followed by TUUC. Postoperatively, the patient developed anastomotic stenosis, initially managed with stent placement. However, left flank pain and oliguria persisted, and imaging revealed grade 2 left hydronephrosis and elevated creatinine levels. Two operators performed the procedure, using antegrade access percutaneously as a guiding approach and retrograde access through the TUUC orifice to perform the holmium laser endoureterotomy. The holmium laser endoureterotomy was successfully performed using a dual-access technique, combining both antegrade and retrograde approaches to enhance precision and minimize tissue damage. Post-procedure, the patient experienced significant relief from symptoms, and renal function improved markedly, with decreased creatinine levels. This case underscores the effectiveness of a combined approach of holmium laser endoureterotomy in managing TUUC-related stenosis. It offers a minimally invasive solution for maintaining patency and enhancing patient outcomes after complex urinary diversion procedures.

Keywords: holmium laser; minimally invasive surgery; transuretero-ureterocutaneostomy; ureteral stenosis; urinary diversion.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board (IRB) of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada issued approval KE/FK/0563/EC/2025. The IRB confirmed that the research complies with all applicable ethical standards for studies involving human subjects. . Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Stenosis of TUUC anastomosis
A. Antegrade contrast pyelography showed the stenosis in TUCC (red arrow). B. Stenosis in TUUC anastomosis. C. Antegrade stent in ureter D. Wire to open the tract of TUUC. TUUC: transuretero-ureterocutaneostomy
Figure 2
Figure 2. Positioning of the operator in the stenosis TUUC anastomosis surgery
TUUC: transuretero-ureterocutaneostomy
See this image and copyright information in PMC

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