Complex ureteric strictures present a significant challenge to the endourologist and uro-radiologist. Multiple separate interventions to try to cross the stricture are often attempted. We describe our experience managing a heterogenous patient group using the 'rendezvous' procedure.
16 patients and 18 ureters (one bilateral procedure, and two separate procedures in one patient) underwent rendezvous procedures. Seven patients had coexisting ureteric calculi treated. Each case was followed up for between 3 months and 5 years.
In 16/18 ureters there was a technical success at the time of surgery; successfully crossing the stricture, allowing ureteroscopic access to the ureter, dilating and/or stenting the ureter. 2/18 were unsuccessful; one secondary to advanced malignancy resulting in a uretero-vaginal fistula and the second a failure to remove a retained, displaced ureteric stent. Of the 18 ureteric procedures; 7/18 were stent free at 3 months, improving to 8/18 stent free at 6 months. 4/18 remained nephrostomy dependent (failure of drainage despite stent or failure to stent) at 3 months, increasing to 6/18 being nephrostomy dependent at 6 months. 1/16 remained dialysis dependent with a nephrostomy tube. For those procedures involving ureteric calculi, 6/7 were stone free and 1/5 had a persistent stone fragment requiring further intervention.
A combined approach may decrease the number of separate interventions required, with the aim of removing the need for a long-term nephrostomy, as well as providing opportunity to treat ureteric calculi in the context of stricture disease. Our experience has been that where the rendezvous has been required to treat strictures caused by malignant extrinsic compression, stenting has not been successful; this information is key to informed consent in a group of patients who may have a limited life expectancy.
Urolithiasis. 2018 Jun 29 [Epub ahead of print]
S R Keoghane, S J Deverill, J Woodhouse, V Shennoy, T Johnston, P Osborn
Departments of Urology and Radiology, West Suffolk NHS Foundation Trust, Portsmouth and Bury St Edmunds, Suffolk, UK. ., Departments of Urology and Radiology, Portsmouth NHS Trust, Portsmouth, UK., Departments of Urology and Radiology, West Suffolk NHS Foundation Trust, Portsmouth and Bury St Edmunds, Suffolk, UK.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/29959479
Go Beyond the Abstract and Read a Commentary by the Authors