Commentary on "retrograde incision from orifice (RIO) technique for endoscopic incision of ureterocele: 15 years of outcomes"

Abstract

This commentary critically evaluates the reported outcomes of the retrograde incision from orifice (RIO) technique for endoscopic ureterocele incision. The authors argue that the original study may have underestimated the need for subsequent lower urinary tract reconstruction and that incomplete preoperative and postoperative assessment of vesicoureteral reflux limits the interpretation of its findings. They also note that the reported rates of de novo reflux and postoperative complications appear higher than those reported for alternative endoscopic techniques. Furthermore, they question the universal applicability of the RIO technique, particularly in ectopic ureteroceles where anatomical landmarks may not be clearly identifiable, and emphasize that carefully placed distal puncture techniques remain valuable options for achieving effective decompression while minimizing postoperative reflux.