Skip to main content

Endoscopy — Cystoscopy & Ureteroscopy

Cystoscopy and ureteroscopy are diagnostic, therapeutic and surveillance tools in reconstructive urology, from preoperative planning and intraoperative quality assurance to postoperative surveillance and endoscopic management of complications.

Part I: Cystoscopy in reconstructive surgery​

Role 1 — Intraoperative injury detection during pelvic reconstructive surgery​

The 2018 AUGS consensus calls for cystoscopy during all prolapse reconstructive operations except isolated posterior repairs; a 2026 systematic review’s Delphi statements call for cystoscopy during uterosacral ligament suspension, while its expert opinion suggests selective use for isolated anterior colporrhaphy, particularly with advanced anterior defects.[1][2][53] This is supported by several findings:

  • In a historical 224-patient series, unsuspected injury occurred in 9 patients (4%).[3]
  • Intraoperative cystoscopy should inspect the bladder and urethra for injury and confirm bilateral ureteral efflux.[1] For uterosacral ligament suspension during primary uterovaginal prolapse repair, a 2026 Delphi consensus says to repeat cystoscopy after sutures are tied if an earlier check was performed under tension.[53] Dyes can aid visualization; select the formulation and route according to its safety profile and local protocol. Visible jets assess patency at that time and do not exclude every partial or delayed thermal injury.[1][2] The distension fluid itself is also a choice: 10% or 50% dextrose is nonconductive, and observers rated ureteric jets clearer with 50% dextrose than with normal saline in a small blinded video comparison.[50][51] Against that visualization benefit, a retrospective cohort found more postoperative UTI with 10% dextrose than normal saline (47.8% vs 25.9%), with transient glucosuria proposed as the mechanism; this favors weighing the infection signal when choosing fluid.[50][51]
  • A review reports that identifying and treating injuries intraoperatively is associated with decreased morbidity, lower healthcare costs and lower litigation risk than delayed detection.[2]
  • A technical report describes transabdominal power Doppler visualization of ureteral jets as an alternative check of ureteral patency during gynecologic surgery, with cystoscopy when jets are absent, diminished or not seen.[4]
  • When marked anterior or apical prolapse obscures the cystoscopic view, a vaginal sponge stick can reduce the prolapse and restore the vesicourethral angle, improving visualization of the ureteral orifices.[52]
  • Suprapubic telescopy has been described as an alternative when the lower urinary tract needs evaluation during open abdominal pelvic surgery: after closing the anterior peritoneum, the bladder is filled retrogradely through a three-lumen Foley, an absorbable purse-string suture is placed through the detrusor at the dome, and a stab incision inside the suture admits a 30-degree telescope; tightening the purse-string limits leakage while the scope moves, and Foley-supplied distension means no separate sheath or bridge is needed.[49] This author-described technique has no comparative safety or outcome data.[49]

Role 2 — Cystoscopy-assisted techniques during ureteral reimplantation​

Cystoscopy plays a direct technical role during certain reimplantation procedures. In a two-patient technical report, Chung et al. described laparoscopic ureteroneocystostomy with psoas hitch using cystoscopy-assisted submucosal tunneling: cystoscopic injection of normal saline into the submucosal plane facilitates creation of the anti-reflux tunnel during minimally invasive reimplantation.[5]

The separate question of screening cystoscopy before pediatric reimplantation for primary reflux was studied retrospectively in 128 children in 2001. One unsuspected ureterocele was found, in a child with incomplete bladder imaging, and no operative plan changed. The reported 16.2% cost increment was institution- and era-specific. This supports questioning low-yield screening when imaging is adequate.[6]

Part II: Cystoscopy for postoperative surveillance​

Role 3 — Surveillance after urethroplasty​

Cystoscopy is a component of postoperative surveillance after urethroplasty and detects stricture recurrence directly.[7][8] The EAU 2026 guideline recommends at least one year of follow-up , flexible cystoscopy at three months , and later surveillance adjusted to recurrence risk , with flow and patient-reported measures in its risk-based protocols.[45]

The AUA Urethral Stricture Disease Guideline advises monitoring to identify symptomatic recurrence after dilation, direct vision internal urethrotomy or urethroplasty . Its text states that urethrocystoscopy, urethral ultrasound or retrograde urethrography, alone or combined, appears to provide the most definitive confirmation of recurrence, and that no specific lumen diameter has been shown to be diagnostic of recurrence.[7] Evidence on cystoscopic surveillance:

  • Goonesinghe et al. prospectively followed 144 post-urethroplasty patients with flexible urethroscopy at 3, 6, and 12 months and annually thereafter. 26 of 27 recurrences requiring treatment were detected in the first year. Flow data were available in only 11 of those 27; seven exceeded 15 mL/s.[9] Thin diaphragms and more substantial restenosis were described.[9]
  • Amend et al. (TURNS multi-institutional study, 304 patients, median 64-month follow-up) reported that early surveillance urethroscopy findings predicted long-term outcomes. Secondary intervention was performed in 64% of patients with small-caliber (<17 Fr) recurrences, 18.3% of those with lumens ≥17 Fr and 15% of those with normal lumens.[10]
  • Baradaran et al. (TURNS, 1054 patients) found that many patients with cystoscopic recurrence do not ultimately need intervention; at median 350-day follow-up, 33.8% of small-caliber recurrences and 6.2% of large-caliber recurrences required secondary procedures.[11] Quality of life was not significantly different among groups.[11]

Among 142 GURS survey respondents, 111 used objective follow-up testing and 64 of those 111 (57.7%) used cystoscopy.[12]

Recurrence surveillance and leak assessment are separate questions. Calvo and Rourke compared 100 bulbar urethroplasty patients with VCUG against 100 matched controls without imaging and found no significant difference in 90-day complications or recurrence. EAU guidance states that extravasation should be assessed before catheter removal, by pericatheter retrograde urethrography, retrograde urethrography or VCUG, and that low-grade ("wisp-like") extravasation does not appear to affect the long-term restricture rate.[45] Subsequent follow-up is tailored to repair type and recurrence risk; see RUG/VCUG.[13][45]

A bulbar stricture that recurs unusually quickly, or has an irregular, moth-eaten appearance on cystoscopy or urethrography, in a middle-aged or older patient should raise concern for primary urethral malignancy and prompt biopsy; this is an expert caution, not a validated prediction rule, and an irregular contour alone is not a cancer diagnosis.[48]

Role 4 — Surveillance after bladder augmentation: malignancy screening​

The role of routine surveillance cystoscopy after augmentation cystoplasty remains controversial, with conflicting recommendations:[14][15][16][17]

Arguments for surveillance:

  • A systematic review of mostly low-quality reports found malignancy proportions ranging 0–5.5% with mean latency around 19 years. Adenocarcinoma is the most common type (51.6%), predominantly at the entero-urinary anastomosis.[15]
  • Soergel et al. reported 3 patients with TCC after AC for neuropathic bladder, all of whom died of metastatic disease, and recommended endoscopic surveillance beginning 10 years after surgery.[17]
  • Garnier et al. found that 13 of 16 patients with post-AC malignancy were diagnosed at advanced stage, with only 56% 1-year survival.[18]
  • A small prospective FISH study enrolled 36 patients; 24 received FISH testing, 32 underwent biopsy, and only two cancers were found. Its reported 100% sensitivity and 95% specificity are too imprecise and selectively verified to establish a routine screening strategy.[19]

Arguments against routine surveillance:

  • Hamid et al. prospectively evaluated 92 patients with enterocystoplasty (median follow-up 15 years): no cancer was identified by screening cystoscopy; 53 patients also consented to biopsies. The only malignancy was diagnosed in a symptomatic patient who had previously had a normal surveillance cystoscopy.[14]
  • Higuchi et al. enrolled 65 patients at least 10 years after augmentation; 50 remained on protocol. During the first five surveillance years, 250 cytologies and 250 endoscopies found no malignancy. Routine endoscopy and cytology was then discontinued while annual clinical assessment continued.[16]
  • Kokorowski et al. (decision analysis) found annual screening cystoscopy and cytology after AC in spina bifida patients had only an 11% chance of being cost-effective at a $100,000 / life-year threshold.[20]
  • Higuchi et al. (matched cohort) found no significant difference in bladder-cancer incidence between augmented patients and matched controls with congenital bladder dysfunction (4.6% versus 2.6%, p=0.54).[21]

Guideline-based follow-up. For adult NLUTD patients with bowel-segment urinary reconstruction, AUA/SUFU recommends annual history and examination, metabolic testing, and urinary-tract imaging.[22] Its Statement 60 recommends cystoscopy for gross hematuria or symptomatic recurrent UTI after bowel reconstruction, and Statements 19 and 20 (Strong Recommendations, Grade B) advise against screening or surveillance cystoscopy in NLUTD, including with a chronic indwelling catheter.[22][59] The Statement 58 annual bundle is an Expert Opinion.[22] The guideline text adds that hematuria, unexplained recurrent UTI or suprapubic pain should prompt full evaluation, including cystoscopy, cytology and CT. Continue lifelong reconstruction follow-up even when scheduled cancer-screening cystoscopy is omitted.[22][14]

Gastric segments need individualized specialist review. A historical series reported two metastatic cancers among 72 gastrocystoplasty patients and its authors advocated annual cystoscopy and biopsy.[23]

Role 5 — Cystoscopy for bladder neck contracture and VUAS​

Cystoscopy is the diagnostic reference and the therapeutic platform for BNC and VUAS. A large prostatectomy registry used symptoms plus inability to pass a 17 Fr cystoscope to define VUAS for that study.[7][24]

Cystoscopy serves as the vehicle for all endoscopic treatments:

  • Direct vision internal urethrotomy (DVIU) with cold knife or holmium laser can treat selected nonobliterative posterior stenosis. During DVIU for VUAS or radiation-induced bulbomembranous stenosis, avoid deep 6 and 12 o’clock incisions because of rectal injury and urosymphyseal fistulation, respectively ; counsel about new or worsened incontinence .[25][45]
  • Balloon dilation is an option for selected nonobliterative posterior stenosis. Do not use endoluminal treatment for completely obliterated VUAS, bulbomembranous stenosis or bladder neck stenosis .[45]
  • Intralesional adjuncts have been described, but posterior MMC injection has caused rare severe necrosis, osteitis pubis, and fistula. The EAU 2026 guideline advises that MMC for nontraumatic posterior urethral stenosis be used only within a clinical trial.[45] See antimitotic/antifibrotic agents.[25][26]
  • Transurethral incision with transverse mucosal realignment. A cystoscopic technique using a laparoscopic suturing device transurethrally to bring healthy bladder mucosa across the defect (analogous to an endoscopic Y-V plasty), with 89% 17-Fr cystoscope passage at four months after one procedure and 100% after two in an initial 19-patient retrospective series (median follow-up six months). Long-term durability and comparative benefit remain uncertain.[27]

Rozanski et al. retrospectively studied 86 patients: composite success (17-Fr cystoscope passage without catheterization or additional procedures) was 65% after one treatment and 90% after repeat treatments overall, with 94% in nonradiated versus 76% in radiated patients (median follow-up 21.1 months).[26]

Part III: Ureteroscopy in reconstructive surgery​

Role 6 — Diagnostic evaluation of ureteral strictures​

Ureteroscopy can clarify an uncertain ureteral lesion and facilitate selected treatment. Combine it with imaging of the stricture and renal unit; an impassable lumen limits what can be inspected. If upper-tract malignancy is suspected and imaging/cytology are insufficient, diagnostic ureteroscopy can support diagnosis and risk assessment.[47]

For ureteral strictures specifically, ureteroscopy allows:

  • Direct visualization of stricture morphology, length, and degree of obliteration.
  • Targeted tissue biopsy when malignancy is a concern. Small samples may miss disease or undergrade or understage it; a negative biopsy does not automatically prove a benign stricture.[47]
  • Assessment of mucosal quality proximal and distal to the stricture.
  • Guidewire passage to determine whether the stricture is traversable.

Role 7 — Endoscopic treatment of benign ureteral strictures​

Endoscopic management is a first-line option for selected ureteral strictures, although Ou et al. describe reconstruction as the gold standard for definitive management:[28][29][30]

TechniqueSelection and evidenceMain limitation
Balloon dilationBest results in selected short (≤2 cm), nonobliterative strictures; a 19-series meta-analysis found 89% technical success, 60% at three months and 54% at 6–12 months. Onset within 3 months showed a nonsignificant trend to better results[30]Ischemic/long strictures fare less well
EndoureterotomyCan treat selected short benign strictures; Razdan reported 74% overall success among 50 endoscopically treated patients with ureteral strictures of mixed causes, including malignant and ureteroenteric strictures; a separate mixed balloon-dilation and/or laser-incision series reported 29/34 (85%) endoscopic success[29][31]Ischemia is not itself an indication favoring incision
Balloon dilation + endoureterotomySome retrospective distal-ureter series report better outcomes with combination treatmentNo established universal superiority; selection and treatment protocols differ
Endoluminal Allium stent after incision/dilationGao's 25-patient series reported 23/25 successes at median 12 months[33]Called “ureteric bypass” by the authors; this is endoluminal stenting, not an extra-anatomic bypass. Limited durability data
[29][30][31][32][33][34]

Comparison with reconstruction. Ou et al. retrospectively compared 95 endoscopically treated and 47 reconstructed patients: success (symptomatic improvement and radiographic relief of obstruction) was 51.6% versus 95.7% (p<0.01).[28] Treatment selection was not randomized.[28]

In that cohort, short proximal or distal strictures and mild-to-moderate hydronephrosis were favorable endoscopic features; reported median time to recurrence after endourological treatment was 51 months. Select treatment individually and continue follow-up because recurrence can be delayed.[28]

Role 8 — Endoscopic management of ureteroenteric anastomotic strictures​

Ureteroscopy plays a role in managing ureteroenteric anastomotic strictures (UEAS) after urinary diversion, for which Katims et al. cite a 3–10% incidence.[35][36][37][38] In a retrospective robot-assisted radical cystectomy cohort, 51 patients (13%) developed UEAS; estimated cumulative incidence was 19% at five years:[55]

Antegrade approach (via percutaneous nephrostomy tract). In a multi-institutional robotic-revision cohort after cystectomy, 4 of 58 affected renal units had malignant strictures; evaluate suspicious narrowing with imaging, cytology and targeted biopsy when indicated before endoscopic treatment.[56][47] Katims et al. described a technique of antegrade flexible ureteroscopy with biopsy, followed by laser incision, triamcinolone injection, balloon dilation to 24 Fr, and temporary parallel double-J stents or upside-down nephrostomy tubes, with 20/24 strictures patent in 21 patients at median 30-month follow-up.[35] The small Katims single-arm series cannot isolate steroid injection's contribution or yield a general success rate.[35]

Retrograde approach (through the conduit or neobladder). More challenging due to altered anatomy and absence of standard landmarks. Costamagna et al. described using a side-viewing duodenoscope to access the ureteroileal anastomosis in Bricker conduits, achieving initial technical success in 19/24 complications among 17 patients. Fourteen successfully treated patients were followed; some still required stents.[39]

Combined antegrade-retrograde approach. Delvecchio et al. described this in five patients: an antegrade nephrostogram provides better anatomical delineation, while through-and-through access enables rapid identification of stenotic segments hidden by mucosal folds and allows use of larger endoscopes with better irrigation.[40]

Endoscopic versus open revision. Van Son et al. retrospectively evaluated 76 patients receiving 161 procedures (26 open, 135 endoscopic) over a 27-year period and found that at 60 months, patency rates were 69% after open revision versus 27% after endoscopic treatment (p=0.003), with median patency duration of 15.5 versus 5 months.[37] Endoscopic treatment can defer revision in selected patients; a 2026 meta-analysis found greater laser success for ureteroenteric strictures <1 cm.[54] A 2026 systematic review of first-time treatment for benign ureteroenteric strictures in adults included 31 studies (858 patients); seven comparative cohorts (368 renal units) found higher primary patency after open revision than endoscopic treatment (RR 2.31, 95% CI 1.54–3.47), with more minor complications after open revision.[54] Success definitions and patient selection varied substantially.[54] Results vary: another series found 20/28 UEAS successfully treated at median 25 months.[36]

Role 9 — Stone management in reconstructed urinary tracts​

Ureteroscopy and cystoscopy are used in managing urolithiasis, one of the most common long-term complications of urinary reconstruction:

  • Reported cumulative stone incidence after augmentation is 28–36% at 10 years. Among adults with bladder augmentation who have previously formed stones, reported recurrence is 15–44%.[46]
  • Antegrade flexible ureteroscopy is one option when diversion anatomy limits retrograde access. In Stuurman et al.'s small series of 17 patients/21 procedures (15 stone procedures and six stricture procedures), 80% of patients treated for stones were stone-free after the first antegrade session.[41]
  • The antegrade approach is used when retrograde access is impossible or extremely difficult because of altered anatomy (continent pouches, neobladders with afferent limbs).
  • Reservoir stone access must protect the urethra and continence channel. EAU notes that channel instrumentation can damage its continence mechanism; percutaneous or open removal is often preferred when safe natural-orifice access is unavailable.[46]

Role 10 — Ureteroscopy as a cause of ureteral strictures: iatrogenic considerations​

Ureteroscopy is associated with ureteral stricture, which reconstructive surgeons may be asked to repair:[42][43]

  • Sunaryo et al. studied 329,776 patients treated with ureteroscopy, shock-wave lithotripsy, or both. Stricture was coded in 2.9% of the ureteroscopy group versus 1.5% of the lithotripsy-only group (adjusted OR 1.71). SWL was a treated comparator, not an untreated stone-only control. Of those with strictures after ureteroscopy, 35% required drainage, 21% had endoscopic intervention, 4.8% required reconstructive surgery, and 1.7% underwent nephrectomy.[43]
  • Ulvik et al. performed 1001 ureteroscopies in 725 patients; among 995 analyzable cases, 28 strictures were found on CT at three months. Independent risk factors included ureteral access sheath use (OR 4.6), ureteral perforation (OR 11.8), and operative time >60 minutes (OR 5.7).[42]
  • In the Ulvik series, dilation succeeded in 15/20 treated strictures in a selected subset.[42]

A 43-study meta-analysis of adult urolithiasis treatments estimated post-ureteroscopy ureteral stricture rates of 1.9% overall and 4.9% with impacted stones; preoperative hydronephrosis, intraoperative perforation and stone impaction were associated with higher stricture odds after endoscopic treatment.[58] These observational associations support careful access, avoidance of force and perforation, and reassessment of difficult or prolonged procedures. Sheath choice should reflect anatomy, pressure and irrigation needs, and the procedure.

Part IV: Endoscopy in catheterizable channel management​

Role 11 — Evaluating and treating channel complications​

Cystoscopy through catheterizable channels is used in managing the most common complications:

  • Stomal or deeper channel stenosis. Cystoscopy through the channel identifies the level and severity of stenosis, guides dilation, and determines whether open revision is needed.
  • False passage formation. Endoscopic evaluation identifies the false tract and true lumen and guides catheter placement. In adults without a patent urethral outlet, failed channel catheterization requires emergent intervention; a pediatric cystoscope or ureteroscope can assess suspected channel trauma.[57]
  • Channel incontinence. Endoscopy may identify a structural problem, but cannot alone distinguish channel failure from an unsafe or overfilled reservoir; assess storage and emptying as well.
  • Reservoir stones. Choose access that preserves the channel. Avoid forcing a scope or instrument through resistance; larger burdens may require percutaneous or open removal.[46]

Part V: Endoscopy in gender-affirming reconstruction​

Role 12 — Managing neourethral complications after phalloplasty​

Endoscopy contributes to evaluation of suspected urethral complications after phalloplasty. Reported fistula and stricture rates vary substantially by technique, follow-up, and source of outcome reporting; alternate cohorts in a review covering phalloplasty and metoidioplasty reported fistula rates of 39.5–56.4% and stricture rates of 31.8–65.5%. Endoscopic assessment identifies:[44]

  • Stricture location (most commonly at the pars fixa–pars pendulans junction).
  • Fistula tracts and their relationship to the neourethra.
  • Diverticula within the neourethra.
  • Stone formation within the neourethral segment.

For selected short, nonobliterative anastomotic strictures, incision may be considered after tissue healing. EAU advises against incision or urethroplasty in the first six months after neophalloplasty and against more than two endoscopic incisions except palliation. Significant early obstruction may require suprapubic drainage; involve a reconstructive team familiar with the neourethral anatomy.[45]

Summary table — roles of cystoscopy and ureteroscopy in reconstructive surgery​

Clinical contextEndoscopic rolePrincipleRefs
Pelvic reconstructive surgeryIntraoperative cystoscopy to confirm ureteral effluxAUGS consensus statement: universal cystoscopy (except posterior-compartment-only operations)1, 2
Post-urethroplasty surveillanceFlexible cystoscopy at 3, 6 and 12 months in one prospective seriesSmall-caliber (<17 Fr) recurrence predicts need for reintervention9, 10, 11
Post-augmentation cystoplastyCystoscopy for symptoms or concerning findings; screening remains debatedAUA/SUFU advises against routine screening in adult NLUTD and recommends cystoscopy for gross hematuria or symptomatic recurrent UTI after bowel reconstruction; review gastric segments individually[22]14, 15, 16, 22, 23
BNC / VUASDiagnosis, dilation, or incision when indicatedMMC is not routine; EAU advises it be used within clinical trials[45]7, 24–27, 45
Ureteral stricturesDiagnostic ureteroscopy + endoureterotomy / dilationEndoscopic outcomes are better in selected strictures ≤2 cm; reconstruction had higher overall success in a retrospective comparison28, 29, 30
Ureteroenteric stricturesSelected antegrade, retrograde, or combined treatmentHeterogeneous case-series outcomes; consider durable reconstruction and renal preservation35–40
Stones in reconstructed tractsAntegrade URS or cystoscopic lithotripsyChoose access by stone burden/anatomy; protect continence channels41
Catheterizable channel complicationsCystoscopy through channelDefines anatomy; assess reservoir function and avoid channel injury—
Post-phalloplasty neourethral complicationsCystoscopy / urethroscopyIdentifies stricture location, fistula, diverticula44
Iatrogenic stricture preventionMeticulous ureteroscopic techniqueRisk associations inform careful technique42, 43

See Also​

References​

1. Cohen SA, Carberry CL, Smilen SW. "American Urogynecologic Society consensus statement: cystoscopy at the time of prolapse repair." Female Pelvic Med Reconstr Surg. 2018;24(4):258–259. doi:10.1097/SPV.0000000000000529

2. Stewart LE, Hall E, Carberry CL. "Cystoscopy at the time of incontinence and prolapse surgery." Curr Opin Obstet Gynecol. 2018;30(6):441–445. doi:10.1097/GCO.0000000000000499

3. Harris RL, Cundiff GW, Theofrastous JP, et al. "The value of intraoperative cystoscopy in urogynecologic and reconstructive pelvic surgery." Am J Obstet Gynecol. 1997;177(6):1367–1369. doi:10.1016/s0002-9378(97)70077-2

4. Cola A, Barba M, Frigerio M. "Intraoperative ultrasound assessment of ureteral patency during pelvic surgery." Int Urogynecol J. 2021;32(12):3313–3315. doi:10.1007/s00192-021-04901-z

5. Chung H, Jeong BC, Kim HH. "Laparoscopic ureteroneocystostomy with vesicopsoas hitch: nonrefluxing ureteral reimplantation using cystoscopy-assisted submucosal tunneling." J Endourol. 2006;20(9):632–638. doi:10.1089/end.2006.20.632

6. Lopes JF, Cendron M, Ellsworth PI. "Cystoscopy at the time of ureteral reimplantation for primary vesicoureteral reflux: is it necessary? Incidence of undetected anomalies and cost." Urology. 2001;57(6):1156–1159. doi:10.1016/s0090-4295(01)01049-4

7. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. "Urethral stricture disease guideline amendment (2023)." J Urol. 2023;210(1):64–71. doi:10.1097/JU.0000000000003482

8. Angermeier KW, Rourke KF, Dubey D, Forsyth RJ, Gonzalez CM. "SIU/ICUD consultation on urethral strictures: evaluation and follow-up." Urology. 2014;83(3 Suppl):S8–17. doi:10.1016/j.urology.2013.09.011

9. Goonesinghe SK, Hillary CJ, Nicholson TR, Osman NI, Chapple CR. "Flexible cystourethroscopy in the follow-up of posturethroplasty patients and characterisation of recurrences." Eur Urol. 2015;68(3):523–529. doi:10.1016/j.eururo.2015.04.013

10. Amend GM, Nabavizadeh B, Hakam N, et al. "Urethroscopic findings following urethroplasty predict the need for secondary intervention in the long term: a multi-institutional study from Trauma and Urologic Reconstructive Network of Surgeons." J Urol. 2022;207(4):857–865. doi:10.1097/JU.0000000000002353

11. Baradaran N, Fergus KB, Moses RA, et al. "Clinical significance of cystoscopic urethral stricture recurrence after anterior urethroplasty: a multi-institution analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS)." World J Urol. 2019;37(12):2763–2768. doi:10.1007/s00345-019-02653-6

12. Hoare DT, Doiron RC, Rourke KF. "Determining perioperative practice patterns in urethroplasty: a survey of genitourinary reconstructive surgeons." Urology. 2021;156:263–270. doi:10.1016/j.urology.2021.05.067

13. Calvo CI, Rourke KF. "Routine imaging after bulbar urethral reconstruction does not impact surgical outcomes and may not be necessary." Urology. 2024;186:41–47. doi:10.1016/j.urology.2024.02.029

14. Hamid R, Greenwell TJ, Nethercliffe JM, et al. "Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary?" BJU Int. 2009;104(3):392–395. doi:10.1111/j.1464-410X.2009.08401.x

15. Biardeau X, Chartier-Kastler E, Rouprêt M, Phé V. "Risk of malignancy after augmentation cystoplasty: a systematic review." Neurourol Urodyn. 2016;35(6):675–682. doi:10.1002/nau.22775

16. Higuchi TT, Fox JA, Husmann DA. "Annual endoscopy and urine cytology for the surveillance of bladder tumors after enterocystoplasty for congenital bladder anomalies." J Urol. 2011;186(5):1791–1795. doi:10.1016/j.juro.2011.07.028

17. Soergel TM, Cain MP, Misseri R, et al. "Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder." J Urol. 2004;172(4 Pt 2):1649–1651. doi:10.1097/01.ju.0000140194.87974.56

18. Garnier S, Vendrell J, Boillot B, et al. "Malignancy after augmentation enterocystoplasty: a nationwide study of natural history, prognosis, and oncogene panel analysis." J Urol. 2020;204(1):136–143. doi:10.1097/JU.0000000000000752

19. Ceyhan E, Mammadov E, Onder SC, Dogan HS, Tekgul S. "FISH: a promising screening tool for malignancy after augmentation cystoplasty?" J Pediatr Surg. 2024;59(4):725–730. doi:10.1016/j.jpedsurg.2023.11.006

20. Kokorowski PJ, Routh JC, Borer JG, et al. "Screening for malignancy after augmentation cystoplasty in children with spina bifida: a decision analysis." J Urol. 2011;186(4):1437–1443. doi:10.1016/j.juro.2011.05.065

21. Higuchi TT, Granberg CF, Fox JA, Husmann DA. "Augmentation cystoplasty and risk of neoplasia: fact, fiction, and controversy." J Urol. 2010;184(6):2492–2496. doi:10.1016/j.juro.2010.08.038

22. Ginsberg DA, Boone TB, Cameron AP, et al. "The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up." J Urol. 2021;206(5):1106–1113. doi:10.1097/JU.0000000000002239. Full AUA/SUFU guideline, statements 19–20, 58 and 60

23. Vemulakonda VM, Lendvay TS, Shnorhavorian M, et al. "Metastatic adenocarcinoma after augmentation gastrocystoplasty." J Urol. 2008;179(3):1094–1096. doi:10.1016/j.juro.2007.10.089

24. Britton CJ, Sharma V, Fadel AE, et al. "Vesicourethral anastomotic stenosis following radical prostatectomy: risk factors, natural history, and treatment outcomes." J Urol. 2023;210(2):312–322. doi:10.1097/JU.0000000000003488

25. Klein R, Vasan R, Guercio C, Rusilko P. "Minimally invasive management of posterior urethral stricture/stenosis with DVIU and mitomycin C injection." Urology. 2024;183:e317–e319. doi:10.1016/j.urology.2023.10.006

26. Rozanski AT, Zhang LT, Holst DD, et al. "The effect of radiation therapy on the efficacy of internal urethrotomy with intralesional mitomycin C for recurrent vesicourethral anastomotic stenoses and bladder neck contractures: a multi-institutional experience." Urology. 2021;147:294–298. doi:10.1016/j.urology.2020.09.035

27. Abramowitz DJ, Balzano FL, Ruel NH, Chan KG, Warner JN. "Transurethral incision with transverse mucosal realignment for the management of bladder neck contracture and vesicourethral anastomotic stenosis." Urology. 2021;152:102–108. doi:10.1016/j.urology.2021.02.035

28. Ou Y, Zhang G, Zhu X, et al. "Evaluation of risk factors, treatment options, and prognostic-related factors in patients with benign ureteral strictures: an 8-year single-center experience." Int J Urol. 2023;30(10):847–852. doi:10.1111/iju.15211

29. Razdan S, Silberstein IK, Bagley DH. "Ureteroscopic endoureterotomy." BJU Int. 2005;95(Suppl 2):94–101. doi:10.1111/j.1464-410X.2005.05207.x

30. Lu C, Zhang W, Peng Y, et al. "Endoscopic balloon dilatation in the treatment of benign ureteral strictures: a meta-analysis and systematic review." J Endourol. 2019;33(4):255–262. doi:10.1089/end.2018.0797

31. Corcoran AT, Smaldone MC, Ricchiuti DD, Averch TD. "Management of benign ureteral strictures in the endoscopic era." J Endourol. 2009;23(11):1909–1912. doi:10.1089/end.2008.0453

32. Richter F, Irwin RJ, Watson RA, Lang EK. "Endourologic management of benign ureteral strictures with and without compromised vascular supply." Urology. 2000;55(5):652–657. doi:10.1016/s0090-4295(00)00484-2

33. Gao X, Chen J, Wang W, et al. "Step-by-step technique for the endoscopic treatment of ureteric stricture." BJU Int. 2021;128(6):692–696. doi:10.1111/bju.15558

34. Wang B, Gao W, Yang K, et al. "Analysis of the efficacy and risk factors for failure of balloon dilation for benign ureteral stricture." J Clin Med. 2023;12(4):1655. doi:10.3390/jcm12041655

35. Katims AB, Edelblute BT, Tam AW, et al. "Long-term outcomes of laser incision and triamcinolone injection for the management of ureteroenteric anastomotic strictures." J Endourol. 2021;35(1):21–24. doi:10.1089/end.2020.0593

36. Gomez FD, Thomas A, Sempels M, et al. "Outcomes following first-line endourologic management of ureteroenteric anastomotic strictures after urinary diversion: a single-center study." Urology. 2017;102:38–42. doi:10.1016/j.urology.2016.10.009

37. van Son MJ, Lock MTWT, Peters M, van de Putte EEF, Meijer RP. "Treating benign ureteroenteric strictures: 27-year experience comparing endourological techniques with open surgical approach." World J Urol. 2019;37(6):1217–1223. doi:10.1007/s00345-018-2475-4

38. Lobo N, Dupré S, Sahai A, Thurairaja R, Khan MS. "Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures." Nat Rev Urol. 2016;13(8):447–455. doi:10.1038/nrurol.2016.104

39. Costamagna G, Shah SK, Mutignani M, et al. "Use of a duodenoscope to manage complications at the ureteroileal anastomotic site after total urinary bladder resection and the Bricker procedure." Gastrointest Endosc. 2002;55(2):242–248. doi:10.1067/mge.2002.120888

40. Delvecchio FC, Kuo RL, Iselin CE, Webster GD, Preminger GM. "Combined antegrade and retrograde endoscopic approach for the management of urinary diversion-associated pathology." J Endourol. 2000;14(3):251–256. doi:10.1089/end.2000.14.251

41. Stuurman RE, Al-Qahtani SM, Cornu JN, Traxer O. "Antegrade percutaneous flexible endoscopic approach for the management of urinary diversion-associated complications." J Endourol. 2013;27(11):1330–1334. doi:10.1089/end.2012.0371

42. Ulvik Ø, Harneshaug JR, Gjengstø P. "Ureteral strictures following ureteroscopic stone treatment." J Endourol. 2021;35(7):985–990. doi:10.1089/end.2020.0421

43. Sunaryo PL, May PC, Holt SK, et al. "Ureteral strictures following ureteroscopy for kidney stone disease: a population-based assessment." J Urol. 2022;208(6):1268–1275. doi:10.1097/JU.0000000000002929

44. Blasdel G, Dy GW, Nikolavsky D, et al. "Urinary reconstruction in genital gender-affirming surgery: checking our surgical complication blind spots." Plast Reconstr Surg. 2024;153(4):792e–803e. doi:10.1097/PRS.0000000000010813

45. European Association of Urology. Urethral Strictures Guidelines. 2026. Male disease management; perioperative care; transgender patients.

46. European Association of Urology. Urolithiasis Guidelines: Bladder Stones. 2026. Guideline.

47. European Association of Urology. Upper Urinary Tract Urothelial Cell Carcinoma: Diagnosis. 2026. Guideline.

48. Dahiya N, Menias CO, Siegel CL. Imaging of the Male Urethra. In: Brandes SB, Morey AF, eds. Advanced Male Urethral and Genital Reconstructive Surgery. 2nd ed. Humana Press; 2014:51-68. doi:10.1007/978-1-4614-7708-2_5

49. Cundiff GW, Bent AE. Cystourethroscopy. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 5th ed. Elsevier; 2021:1373-1406.

50. Siff LN, Unger CA, Jelovsek JE, Paraiso MF, Ridgeway BM, Barber MD. Assessing Ureteral Patency Using 10% Dextrose Cystoscopy Fluid: Evaluation of Urinary Tract Infection Rates. Am J Obstet Gynecol. 2016;215(1):74.e1-6. doi:10.1016/j.ajog.2016.02.006

51. Narasimhulu DM, Prabakar C, Tang N, Bral P. 50% Dextrose Versus Normal Saline as Distension Media During Cystoscopy for Assessment of Ureteric Patency. Eur J Obstet Gynecol Reprod Biol. 2016;199:38-41. doi:10.1016/j.ejogrb.2016.01.038

52. Kowalik C, Souders C, Cohn JA. Surgical, Radiographic, and Endoscopic Anatomy of the Female Pelvis. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 13th ed. Elsevier; 2025:2067-2083.

53. Santis-Moya F, Wolff DT, Koven A, et al. "Management of major non-mesh complications after primary uterovaginal prolapse surgery: a systematic review." Int Urogynecol J. 2026;online ahead of print. doi:10.1007/s00192-026-06888-x

54. Kendrekar P, Bhatia A, Bakbak H, et al. "Open vs endoscopic management of benign ureteroenteric anastomotic strictures: a systematic review and meta-analysis." J Endourol. 2026;online ahead of print. doi:10.1177/08927790261472745

55. Ahmed YE, Hussein AA, May PR, et al. "Natural history, predictors and management of ureteroenteric strictures after robot assisted radical cystectomy." J Urol. 2017;198(3):567–574. doi:10.1016/j.juro.2017.02.3339

56. Ghodoussipour S, Ahmadi N, Goh A, et al. "Robotic repair of ureteroenteric stricture following radical cystectomy: a multi-institutional experience." Urology. 2022;161:125–130. doi:10.1016/j.urology.2021.11.020

57. Pagliara TJ, Gor RA, Liberman D, et al. "Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults." Can Urol Assoc J. 2018;12(3):E126–E131. doi:10.5489/cuaj.4656

58. Moretto S, Saita A, Scoffone CM, et al. "Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis." World J Urol. 2024;42(1):234. doi:10.1007/s00345-024-04933-2

59. Ginsberg DA, Boone TB, Cameron AP, et al. "The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation." J Urol. 2021;206(5):1097–1105. doi:10.1097/JU.0000000000002235