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Urolithiasis

, Volume 47, Issue 4, pp 383–390 | Cite as

Combined antegrade and retrograde access to difficult ureters: revisiting the rendezvous technique

  • S. R. KeoghaneEmail author
  • S. J. Deverill
  • J. Woodhouse
  • V. Shennoy
  • T. Johnston
  • P. Osborn
Original Paper

Abstract

Introduction

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.

Methods and materials

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.

Results

In 16/18 ureters there was technical success at 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.

Conclusions

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.

Keywords

Ureteric stricture Ureteroscopy Rendezvous technique Ureteric obstruction 

Notes

Authors’ contribution

Deverill—data collection and writing. Osborne, Woodhouse, Shennoy—performed cases. Johnston—manuscript editing. Keoghane—senior author, surgeon, editing and project developer.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.

Informed consent

Informed consent was obtained from patients prior to each operation.

References

  1. 1.
    Bagley DH, Huffman J, Lyon E et al (1985) Endoscopic ureteropyelostomy: opening the obliterated ureteropelvic junction with nephroscopy and flexible ureteropyeloscopy. J Urol 133:462–464CrossRefGoogle Scholar
  2. 2.
    Watson JM, Dawkins GPC, Whitfield HN et al. 2002 The rendezvous procedure to cross complicated ureteric strictures. BJU Int 89(3):317–319Google Scholar
  3. 3.
    Anderson H, Alyas F, Edwin PJ (2005) Intra-urinoma rendezvous using a transconduit approach to re-establish ureteric integrity. Cardiovasc Intervent Radiol 28:95–97CrossRefGoogle Scholar
  4. 4.
    Doody O, Given MF, Harper M et al (2008) Rendezvous technique following thermal ureteric injury after radiofrequency ablation in a solitary kidney. J Vasc Interv Radiol 19(7):1112–1114CrossRefGoogle Scholar
  5. 5.
    Pastore AL, Palleschi G, Silvestri L et al. 2015.Endoscopic rendezvous procedure for ureteral iatrogenic detachment: report of a case series with long-term outcomes. J Endourol 29(4):415–420Google Scholar
  6. 6.
    Liu C, Zhang X, Xue D et al. 2014.Endoscopic realignment in the management of complete transected ureter. Int Urol Nephrol 46:335–340Google Scholar
  7. 7.
    Delvecchio FC, Kuo RL, Iselin CE et al (2000) Combined antegrade and retrograde endoscopic approach for the management of urinary diversion associated pathology. J Endourol 14(3):251–256CrossRefGoogle Scholar
  8. 8.
    Lopatkin NA, Martov AG, Gushchin BL (2000) An endourologic approach to complete ureteropelvic junction and ureteral strictures. J Endourol 14(9):721–726CrossRefGoogle Scholar
  9. 9.
    Gray RJ, Intriere L, Dolmatch BL et al (1992) Combined retrograde antegrade ureteral stent passage: salvage procedure for a ureteral leak. J Vasc Interv Radiol Aug 3(3):557–558CrossRefGoogle Scholar
  10. 10.
    Macri A, Magno C, Certo A et al (2006) Combined antegrade and retrograde ureteral stenting: the rendezvous technique. Clin Radiol 60:257–260CrossRefGoogle Scholar
  11. 11.
    Yates DR, Mehta SS, Spencer PA et al (2010) Combined antegrade and retrograde endoscopic retroperitoneal bypass of ureteric strictures: a modification of the ‘rendezvous’ procedure. BJU Int 105:992–997CrossRefGoogle Scholar
  12. 12.
    Mazzon G, Arumuham V, Dale R, Bolgeri M, Allen S, Smith D, Choong S (2017) The ureteric rendezvous procedure to treat complex discontinuities. J Urol A 176Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • S. R. Keoghane
    • 1
    Email author
  • S. J. Deverill
    • 2
  • J. Woodhouse
    • 2
  • V. Shennoy
    • 1
  • T. Johnston
    • 1
  • P. Osborn
    • 2
  1. 1.Departments of Urology and RadiologyWest Suffolk NHS Foundation TrustSuffolkUK
  2. 2.Departments of Urology and RadiologyPortsmouth NHS TrustPortsmouthUK

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