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Combined antegrade and retrograde endoscopic retroperitoneal bypass of ureteric strictures: a modification of the ‘rendezvous’ procedure
Author(s) -
Yates David R.,
Mehta Sampi S.,
Spencer Paul A.,
Parys Bo T.
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08807.x
Subject(s) - medicine , surgery , ureteric stent , stent , rendezvous , percutaneous nephrostomy , ureter , radiological weapon , radiology , percutaneous , engineering , spacecraft , aerospace engineering
Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To evaluate our experience of treating complicated iatrogenic ureteric strictures with a combined antegrade and retrograde endoscopic retroperitoneal bypass technique, a modification of the so‐called ‘rendezvous’ procedure. PATIENTS AND METHODS Seven patients presented to our institution between 2004 and 2008 after developing a complicated iatrogenic ureteric stricture, impassable with solitary antegrade or retrograde stenting techniques. In most cases there was a significant loss of ureteric continuity, with some strictures of up to 10–12 cm. After initial temporizing management with a percutaneous nephrostomy, each patient had a radiological ‘rendezvous’ procedure to insert a JJ stent and restore ureteric continuity. After 6 months, the JJ stents were removed and the patients evaluated by symptom assessment, serial measurements of serum creatinine and diuretic renography (F‐15 mercaptoacetyl triglycine). RESULTS All seven ‘rendezvous’ procedures were successful and a ureteric stent was inserted across or around the stricture in all cases. Five of seven patients whose follow‐up was >6 months had their stent removed successfully. At a median follow‐up of 21 months, all patients are alive and none has required subsequent surgery. Six of the seven patients presented with significant symptoms and they are all currently symptom‐free, which we consider to be a successful clinical outcome. No patient has developed significant renal impairment (estimated glomerular filtration rate (<30 mL/min) but we could only confirm successful unequivocal renographic drainage in one patient. CONCLUSION Combining antegrade radiological and retrograde endourological techniques, it is possible to restore ureteric continuity with a JJ stent, even in situations with extensive loss of the ureteric lumen. This reduces the need for morbid open surgical repair and offers a long‐term solution to patients who might otherwise be consigned to less favourable conservative measures.