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AUA 2017

AUA 2017: The Ureteric "Rendezvous procedure" to treat complex discontinuities

Boston, MA (UroToday.com) In case of a ureteric injury that presents either early or late, the endoluminial approach is usually the first line treatment. Most of these injuries occur post gynecological procedures. When cases of failed integrate or retrograde approaches happen, the second approach of care is the rendezvous procedure (RP) which involves the antegrade insertion. Uro-radiology is used as a method of assistance to insert a uteric guide wire to the point of obstruction in the ureter. Subsequently, a retrograde method via uterescopy is used to approach the distal ureter to the point of obstruction as well. Both these approaches, along with applied pressure to the ureter, are used in combination to traverse the discontinuity and aid in the placement of a stent. This study examines how effective RP is to treat complex discontinuities.

In this retrospective study, patients who were undergoing RP for ureteric discontinuities and were undergoing at least a 12 month follow up were reviewed thoroughly. Patients were divided into two groups based on their level of stricture or obstruction. Group A contained patients who presented with late oncological/post-surgical stricture and group B contained patients who presented with early post-surgical obstruction, leakage or detachment. According to the authors, these patients do not fall into the textbook ureteric injury implant patients; they are select patients referred from around the country at a young age that do not have any other option. A retrograde study +/- rigid ureteroscopy was performed to assess the stricture after 3 months following the procedure. A MAG3 renogram at 6 and 12 months was performed as a follow up.

Of the 35 patients who underwent a RP, 25 patients were in group A and 10 in group B. In group A, strictures were successfully stented in 21 out of the 25 patients (84%) and in group B, it was placed in 8 out of 10 patients (80%). After a 12 month follow up, 10 out 21 patients in group A required no further intervention and were stent free (48%) while 6 of those patients were maintained with long term stenting (29%). 3 patients required major reconstruction (9%) and 2 patients (9%) died during the follow up period. Group B had 4 out of 8 patients (50%) who were stent free with no further intervention at that 12 month follow up mark and 3 out of 8 patients (38%) remained on long term stenting. One patient required major reconstruction during the follow up period.

In conclusion, the RP procedure through both the antegrade and retrograde approach can bridge complex ureteric strictures. This in return helps avoid major surgery and allows time for recovery and stabilization. The data presented showed that in up to 50% of patients, no further intervention was necessary. According to the authors, RP can be considered as a procedure for high risk patients where the endoluminal approach is not possible or dangerous. This is also a useful procedure for young patients with benign discontinuities and those who prefer not to have an open reconstruction.

Presented by: Vimoshan Arumuhan

Authors: G Mazzon, V Arumuham, M Bolgeri, R Dale, C Allen, S Allen, D Smith, S Choong

Affiliation: Endoourology & Stone Unit, The Institute of Urology, University of London Hospitals NHS Trust, London UK

Written By: Kheira Bettir from the University of California, Irvine for UroToday.com

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA