Supplementary Material for: A Simple and Novel Method to Attain Retrograde Ureteral Access after Previous Cohen Cross-Trigonal Ureteral Reimplantation

Objective: To describe a simple, novel method to achieve ureteric access in the Cohen crossed reimplanted ureter, which will allow retrograde working access via the conventional transurethral method. Materials and Methods: Under cystoscopic vision, suprapubic needle puncture was performed. The needle was directed (bevel facing) towards the desired ureteric orifice (UO). A guidewire (with a floppy-tip) was then inserted into the suprapubic needle passing into the bladder, and then easily passed into the crossed-reimplanted UO. The distal end of the guidewire was then removed through the urethra with cystoscopic grasping forceps. The straightened ureter then easily facilitated ureteroscopy access, retrograde pyelogram studies, and JJ stent insertion in a conventional transurethral method. Results: The UO and ureter were aligned in a more conventional orthotopic course, to allow for conventional transurethral working access. Conclusion: A novel method to access the Cohen crossed reimplanted ureter was described. All previously published methods of accessing the crossed ureter were critically appraised.