Category: Reconstruction: Benign

MP14-7 - Rendezvous procedure to treat complex ureteric discontinuities

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

After ureteric injury, minimally invasive management is the preferred treatment option. Where antegrade or retrograde stent insertion has failed, the rendezvous procedure can regain ureteric continuity, avoiding major reconstructive surgery. The procedure involves antegrade passage of a wire while a ureteroscope visualises the obstruction retrogradely. If the antegrade wire is seen, it is grasped from below and passed across the obstruction. In dense ureteric obliteration, the antegrade wire position can be identified using both fluoroscopy and the ureteroscopic view which detects local tissue movement during wire manipulation. Laser is used to penetrate a gap in the ureter, a dense stricture or to release an obstructing suture to reach the antegrade guidewire and externalise it. The wire is then used to site a stent.


Methods :

A retrospective review of patients undergoing a rendezvous procedure was conducted between 2005 and 2017.  Follow-up was a minimum of 12 months. Patients were divided into two groups: oncological/late post-surgical stricture (group A) and early post-surgical ureteric obstruction/leakage or detachment (group B). Where appropriate, we performed a retrograde study +/- rigid ureteroscopy to assess the stricture 3 months post-operatively followed by MAG3 renogram at 6 and 12 months.


Results :

42 patients underwent a rendezvous procedure during this time period, 27 in group A (age range 45-74) and 15 in group B (age range 36-63).
Ureteric obstructions were successfully stented in 22 out of 27 patients (81%) in Group A and 11 out of 15 in Group B (73%).
At 12 months 12/22 (55%) in group A required no further interventions and were stent free, 5/22 (23%) were maintained with long term stenting and 3/22 (14%) required major reconstruction. 2 patients died during follow up from malignancy.
In group B, 5/11 (45%) were stent free with no further interventions, 3/11 (27%) were maintained with long term stenting and 3/11 (27%) required reconstruction.


Conclusions : With a combined antegrade and retrograde approach, the majority of complex ureteric disruptions in our series could be bridged and stented, avoiding the need for major reconstructive surgery.  For the minority of patients requiring definitive stent-free surgery, the rendezvous procedure can temporise proceedings in often unfavourable circumstances and allow time for the patients to stabilise and recover.

Giuseppe Celentano

Clinical Fellow
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Giorgio Mazzon

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Vimoshan Arumuham

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Michael Mikhail

Trainee
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Sian Allen

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Daron Smith

Consultant Urological Surgeon
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Daron Smith is a consultant urological surgeon at the Institute of Urology at University College Hospital. His practice is "endoluminal endourology" and encompasses the comprehensive management of Urinary Tract Stone disease, and includes the endourological management of ureteric obstruction, ureteric injuries, and the endoscopic diagnosis and management of upper tract TCC. He is the vice-chairman of the BAUS Section of Endourology, having been its Secretary from 2015-17 and a committee member since 2013, is the Consulting Editor on stone disease for the BJUI and the deputy editor of the Journal of Endoluminal Endourology

Simon Choong

Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom