Skip to main content

Endoscopy — Cystoscopy & Ureteroscopy

Cystoscopy and ureteroscopy serve as indispensable diagnostic, therapeutic, and surveillance tools across virtually every domain of reconstructive urology — from preoperative planning and intraoperative quality assurance to postoperative surveillance and endoscopic management of complications. This article catalogs their roles organized by clinical context.

Part I: Cystoscopy in reconstructive surgery​

Role 1 — Intraoperative injury detection during pelvic reconstructive surgery​

The American Urogynecologic Society (AUGS) recommends universal cystoscopy at the time of all pelvic organ prolapse reconstructive operations, with the exception of operations solely for posterior compartment defects.[1][2] This is supported by several key findings:

  • A historical 224-patient series found unsuspected injury in 9 patients (4%); this is not a universal incidence for current prolapse operations.[3]
  • Ureteral efflux must be confirmed bilaterally when cystoscopy is performed during pelvic reconstructive surgery. 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]
  • When injuries are identified and treated intraoperatively, there is decreased morbidity, lower healthcare costs, and lower litigation risk than delayed detection.[2]
  • Power Doppler visualization of jets has been described as an adjunct/alternative technique, but that technical report does not replace the AUGS recommendation for cystoscopy during prolapse repair.[4]

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; it does not address cystoscopy needed for a particular operative technique.[6]

Part II: Cystoscopy for postoperative surveillance​

Role 3 — Surveillance after urethroplasty​

Cystoscopy is the most specific modality for detecting stricture recurrence after urethroplasty and is a critical component of postoperative surveillance.[7][8]

The AUA Urethral Stricture Disease Guideline states that urethrocystoscopy, urethral ultrasound, or retrograde urethrography provides the most definitive confirmation of stricture recurrence.[7] Key evidence supporting 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. Thin diaphragms and more substantial restenosis were described, but morphology alone is not an automatic instruction to dilate or revise.[9]
  • Amend et al. (TURNS multi-institutional study, 304 patients, median 64-month follow-up) demonstrated that early surveillance urethroscopy findings predict long-term outcomes: patients with small-caliber (<17 Fr) recurrences had a significantly higher rate of secondary intervention over long-term follow-up.[10]
  • Baradaran et al. (TURNS, 1054 patients) found that many patients with cystoscopic recurrence do not ultimately need intervention — only 33.8% of small-caliber recurrences and 6.2% of large-caliber recurrences required secondary procedures. Quality of life was not significantly different among groups, suggesting cystoscopy alone may be a poor screening test when defined by patient symptoms.[11]

Practice patterns are not recommendations. Among 142 GURS survey respondents, 111 used objective follow-up testing and 64 of those 111 (57.7%) used cystoscopy.[12]

Separate recurrence surveillance from leak assessment. Calvo and Rourke compared 100 bulbar urethroplasty patients with VCUG against 100 matched controls without imaging and found no significant outcome difference. This observational result does not establish equivalence for every repair. Current EAU guidance still recommends validated urethrography before catheter removal to assess extravasation. Subsequent follow-up is tailored to repair type and recurrence risk; see RUG/VCUG.[13][45]

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; these heterogeneous estimates do not define one individual lifetime risk. 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, underscoring the need for earlier detection.[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/cytology was then discontinued while annual clinical assessment continued. This was five years of a late surveillance program, not an instruction to stop follow-up five years after surgery.[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% vs. 2.6%, p=0.54).[21]

Guideline-based follow-up: For adult NLUTD patients with bowel-segment urinary reconstruction, AUA/SUFU recommends annual history/examination, metabolic testing, and urinary-tract imaging. It recommends cystoscopy for gross hematuria or recurrent symptomatic UTI and opposes routine screening cystoscopy in asymptomatic NLUTD. New unexplained pain also warrants evaluation. 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/biopsy. That is an observational recommendation, not a separate high-certainty guideline mandate or proof of screening benefit.[23]

Role 5 — Cystoscopy for bladder neck contracture and VUAS​

Cystoscopy is both the diagnostic standard and the therapeutic platform for BNC and VUAS. A large prostatectomy registry defined VUAS as symptoms plus inability to pass a 17 Fr cystoscope; this is that study's operational definition, not a universal AUA diagnostic caliber.[7][24]

Cystoscopy serves as the vehicle for all endoscopic treatments:

  • Direct vision internal urethrotomy (DVIU) with cold knife or holmium laser.[25]
  • Balloon dilation of the stenotic segment.
  • Intralesional adjuncts have been described, but posterior MMC injection has caused rare severe necrosis, osteitis pubis, and fistula. EAU advises use only in a clinical trial; it is not a routine step in diagnostic cystoscopy or incision. See antimitotic/antifibrotic agents.[25][26][45]
  • Transurethral incision with transverse mucosal realignment — a novel 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% patency 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: patency 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). Absence of serious events in this selected cohort does not negate the severe complications reported elsewhere or establish the benefit of MMC over incision alone.[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/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 serves as a reasonable first-line treatment for select ureteral strictures, though reconstruction remains the gold standard for definitive management:[28][29][30]

TechniqueSelection and evidenceMain limitation
Balloon dilationBest results in selected short (≤2 cm), recent, nonobliterative strictures; a 19-series meta-analysis found 89% technical success, 60% at three months, and 54% at 6–12 monthsImmediate passage is not durable patency; ischemic/long strictures fare less well
EndoureterotomyCan treat selected short benign strictures; older series report approximately 74–85% successTechnique, cause, perfusion, renal function, and repeat treatments vary; 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 monthsCalled “ureteric bypass” by the authors; this is endoluminal stenting, not an extra-anatomic bypass. Limited durability data
[29][30][31][32][33][34]

Critical comparison with reconstruction: Ou et al. retrospectively compared 95 endoscopically treated and 47 reconstructed patients: success was 51.6% versus 95.7% (p<0.01). Treatment selection was not randomized, so this is not an unbiased comparative efficacy estimate.[28]

In that cohort, short proximal/distal strictures and mild-to-moderate hydronephrosis were favorable endoscopic features; reported median time to recurrence 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 critical role in managing ureteroenteric anastomotic strictures (UEAS) — a complication occurring in 3–10% of patients after urinary diversion:[35][36][37][38]

Antegrade approach (via percutaneous nephrostomy tract) — useful when retrograde access is difficult; route selection depends on anatomy and existing access. Katims et al. described a technique of antegrade flexible ureteroscopy with biopsy, followed by laser incision, triamcinolone injection, balloon dilation to 24 Fr, and parallel double-J stent placement, with 20/24 strictures patent in 21 patients at median 30-month follow-up. This small single-arm series does not establish a universal success rate or the independent contribution of steroid injection.[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. Technical access and stent-dependent drainage are not equivalent to durable stent-free cure.[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 vs. 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 vs. 27% after endoscopic treatment (p=0.003), with median patency duration of 15.5 vs. 5 months. The nonrandomized comparison and repeated procedures limit causal interpretation; endoscopic treatment can still defer a larger operation in selected patients. Results vary: another series found 20/28 UEAS successfully treated at median 25 months.[36][37]

Role 9 — Stone management in reconstructed urinary tracts​

Ureteroscopy and cystoscopy are essential for 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. Recurrence varies across series and populations; 44% is not a universal recurrence rate.[46]
  • Antegrade flexible ureteroscopy is one option when diversion anatomy limits retrograde access. Stuurman et al. reported 80% first-session stone clearance in a small series of 17 patients/21 procedures, of which 15 addressed stones and six strictures; this does not establish a preferred route for every diversion.[41]
  • The antegrade approach is particularly valuable when retrograde access is impossible or extremely difficult due to 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 itself can cause the very strictures that reconstructive surgeons must repair:[42][43]

  • Sunaryo et al. (population-based study, 329,776 patients) found ureteral stricture developed in 2.9% of patients after ureteroscopy — versus 1.5% after shock-wave lithotripsy (adjusted OR 1.71). SWL was a treated comparator, not an untreated stone-only control; residual confounding limits attribution to instrumentation alone. Of those with strictures, 35% required drainage, 21% had endoscopic intervention, 4.8% required reconstructive surgery, and 1.7% underwent nephrectomy.[43]
  • Ulvik et al. (1001 ureteroscopies) identified a 3.0% stricture rate, with independent risk factors including 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; this selected subset does not establish universal first-line superiority.[42]

These observational associations support careful access, avoidance of force and perforation, and reassessment of difficult/prolonged procedures. They do not establish that avoiding access sheaths universally improves outcomes; sheath choice should reflect anatomy, pressure/irrigation needs, and the procedure.

Part IV: Endoscopy in catheterizable channel management​

Role 11 — Evaluating and treating channel complications​

Cystoscopy through catheterizable channels is essential for 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 guides catheter placement into the true lumen.
  • 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/stricture rates vary substantially by technique, follow-up, and source of outcome reporting; selected alternate cohorts reporting roughly 40%/32% are not universal rates. 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/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 roleKey principleRefs
Pelvic reconstructive surgeryIntraoperative cystoscopy to confirm ureteral effluxUniversal cystoscopy recommended (except posterior-compartment only)1, 2
Post-urethroplasty surveillanceFlexible cystoscopy at 3–6 monthsSmall-caliber (<17 Fr) recurrence predicts need for reintervention9, 10, 11
Post-augmentation cystoplastySurveillance cystoscopy for malignancyControversial; symptom-driven cystoscopy preferred over routine14, 15, 16, 22
BNC / VUASDiagnosis, dilation, or incision when indicatedMMC is not routine; EAU limits it to trials7, 24–27, 45
Ureteral stricturesDiagnostic ureteroscopy + endoureterotomy / dilationBest for ≤2 cm strictures; reconstruction superior for longer28, 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 technique; do not imply a universal no-sheath rule42, 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.