Login to Access Video or Poster Abstract: MP50-03
Sources of Funding: None

Introduction

The endoluminal approach is usually the first line to ureteric injury presenting early or late. In the cases of a failed antegrade or retrograde approaches to inserting a ureteric stent, the rendezvous procedure (RP), might be used to increase the success rate. The RP involves the antegrade insertion - with the assistance of uro-radiology, of a ureteric guidewire to the point of obstruction. The distal ureter is subsequently approached in a retrograde fashion via ureteroscopy - to the point of obstruction. A combination of methods can then be employed to traverse the discontinuity which is subsequently stented.

Methods

We retrospectively reviewed patients undergoing RP for ureteric discontinuities, treated between 2005 and 2016 at our Institution and completing at least a 12 month-follow up. We divided patients into two groups: late oncological/post-surgical stricture (group A), or early post-surgical obstruction, leakage or detachment (group B). If appropriate, we performed a retrograde study +/- rigid ureteroscopy to assess the stricture after 3 month from the procedure, followed by a MAG3 renogram at 6 and 12 months.

Results

35 patients underwent a Rendezvous procedure, 25 in group A (Mean age 59.35, range: 49-74), 10 in group B (Mean age 52.44, range: 36-63). Strictures were successfully stented in 21 out of 25 patient (84%) in the group A, 7 out of 10 in group B (70%). After successful stenting, at 12 month 12/21 of group A required no further interventions and were stent free (56%), 7 (32%) were maintained with long term stenting. Only 2 (11%) required major reconstruction, 2 patients (11%) died during follow up from malignancy. In group B, 4/8 (50%) were stent free with no further interventions, 3/8 (38%) were maintained on long term stenting, only 1 required reconstruction.

Conclusions

With a combined antegrade and retrograde approach, the majority of complex ureteric stricture can be bridged and stented, avoiding major surgery in unfavourable circumstances and allows time for stabilisation and recovery of the patient. Interestingly, if successful, further interventions later may be unnecessary in up to 50-57% of patients. This is particularly useful in elderly patients with a malignant stricture, but also perhaps in young patients with benign discontinuities and a good blood supply to the ureter.

Funding

None