Response to Commentary Re Retrograde Incision from Orifice (RIO) Technique for Endoscopic Incision of Ureterocele: 15 Years of Outcomes.

We appreciate the authors' comments on our work detailing our retrograde incision from orifice (RIO) technique [ [1] Oktar T. Selvi I. Kart M. Dönmez M.İ. Çetin B. Boyuk A. et al. Lower urinary tract reconstruction for ectopic ureterocele: what happens in the long-term follow-up?. J Pediatr Surg. 2022 Sep 17; S0022–3468: 566-568 Google Scholar ]. Our study compared 15 years of institutional outcomes for endoscopic management for obstructing ureterocele and found that RIO performed similarly to the more classical low transverse incision. The authors expressed doubt regarding the predictability of ureterocele landmarks, citing the <50% utilization of RIO at our institution. However, it is important to note that our study represents a diverse group of 11 surgeons with varied practice patterns and surgical approaches and not a single-surgeon experience. This intramural heterogeneity allowed for a direct technique comparison. RIO was not performed by all surgeons at our institution, and despite uptake by many thereof after its introduction by a single surgeon [ [2] Maizels M. Liu D. Gong E.M. Kaplan W.E. Cheng E.Y. Endoscopic ureterocele-otomy - retrograde incision from orifice (RIO) of urethral segment of ureterocele and extending to bladder neck is a feasible and simple procedure. J Pediatr Urol. 2016; 12: 137-138https://doi.org/10.1016/j.jpurol.2016.05.010 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ], is not everyone's preference. Among our most prolific endoscopists, RIO was performed in 70%, 85%, 13%, and 82% of cases. Notably, surgeon 3 performed RIO in only 2 of 16 cases, reserving it for cases (as the authors described) with a gaping orifice and thin wall. This is not because of an absence of predictable landmarks, but rather the surgeon's preference for low transverse incision. Commentary on “Retrograde incision from orifice (RIO) technique for endoscopic incision of ureterocele: 15 years of outcomes”Journal of Pediatric UrologyVol. 19Issue 5PreviewCorona et al. [1] reported their surgical outcomes of endoscopic ureterocele incision using the retrograde incision from orifice (RIO) technique. As mentioned by the authors, successful decompression of the obstructive ureteroceles without complication and any need for subsequent secondary surgeries are of great importance. However, there are several points that we believe to be discussed on this subject. Full-Text PDF