Endoscopic Rendezvous Procedure for Ureteral Iatrogenic Detachment: Report of a Case Series with Long-Term Outcomes

Pastore, Antonio Luigi; Palleschi, Giovanni; Silvestri, Luigi; Leto, Andrea; Autieri, Domenico; Ripoli, Andrea; Maggioni, Cristina; Salhi, Yazan Al; Carbone, Antonio

doi:10.1089/end.2014.0474

Cited by 24 publications

(18 citation statements)

References 16 publications

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“…The evaluation of this procedure after 3 months showed disappointing results. Perhaps a stent should have been maintained much longer to allow regeneration of the ureteral wall [6][7][8]. PN secured the kidney from damage.…”

Section: Discussionmentioning

confidence: 99%

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

et al. 2016

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Objectives: To analyzed the therapeutic results for patients with overlooked iatrogenic ureteral injuries after gynecological surgery, treated at the department since 1990. Before the era of endourology, ureteral injuries were operated on immediately after making a diagnosis. This approach was changed after the popularization of percutaneous nephrostomy (PN) and ureteral stenting using a JJ stent. Material and methods:27 patients who were diagnosed with a ureteral injury between the first and sixty-fourth day after injury were included. Only PN was performed in 21 patients (group A). In 6 patients, a JJ stent was introduced either immediately after making a diagnosis or after PN (group B). Results:In group A, a good therapeutic result was obtained in only 6 patients (28.6%). Of the 12 patients subjected to PN up to two weeks after injury, 5 had a good result without a need for repair surgery. Of the 9 patients with an injury diagnosed after 3 weeks, only one had a good therapeutic outcome. In Group B, a good result was achieved in 5 out of 6 patients. In 2 patients, a JJ stent was introduced immediately after making the diagnosis, and, in 3 patients, after PN. A successful attempt to "tunnelize" a complete and long obstruction in the sixth patient failed. Conclusions:Attempting to introduce a JJ stent should be the treatment of choice in patients with an overlooked iatrogenic ureteral injury. If an attempt to introduce the JJ stent fails, PN should be performed as a first step to manage the injury.

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Section: Discussionmentioning

confidence: 99%

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

et al. 2016

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“…This technique entails advancing a catheter and wire through the ureteric gap to be captured from the opposite access using a snare or forceps under fluoroscopic or cystoscopic visualization. [ 2 4 5 6 7 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…Ureteric intussusception during retrograde introduction of double J stent was described in a previous case reported by Pastore et al . [ 6 ] This was managed by introducing the stent retrogradely. Strictures at the site of ureteric injury are commonly encountered due to the extra-anatomical passage of the stent and intense surrounding fibroblastic reaction.…”

Section: Discussionmentioning

confidence: 99%

Image-guided ureteral reconstruction using rendezvous technique for complex ureteric transection after gunshot injuries

et al. 2016

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Management of complex ureteric transection poses a significant clinical challenge, particularly after gunshot injuries due to marked distortion of anatomy and associated tissue loss. We report two cases of total ureteric transection due to gunshot injury successfully repaired using fluoroscopy-guided rendezvous procedure and double J stent placement. This minimally invasive approach may offer a safe and effective technique to repair complete ureteral transection and obviate the need for complex surgical procedures.

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Section: Introductionmentioning

confidence: 99%

“…If stent placement is not possible following ureteral injury, placement of a percutaneous nephrostomy tube is required for renal drainage until elective repair can be accomplished. 1,[8][9][10] Several authors have reported reasonable rates of success with ureteroscopic ureteral realignment for iatrogenic ureteral injury during gynecologic and general surgical procedures. [9][10][11][12][13] However, to our knowledge, there has not been a previous report of successful endoscopic ureteral realignment following avulsion of the ureter at the level of the ureteropelvic junction.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

Tayeb

Mellon

Lingeman

2015

CUAJ

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E882Cite as: Can Urol Assoc J 2015;9(11-12):E882-5 http://dx.doi.org/10.5489/cuaj.2830 Published online December 14, 2015. AbstractWe present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment. IntroductionThe incidence of ureteral injury and overall complications during ureteroscopy ranges from 0 to 28%. [1][2][3][4][5] Iatrogenic ureteral injury varies from minor mucosal petechiae to erosion, perforation, and rarely complete ureteral avulsion. 6 Factors associated with higher complication rates during ureteroscopy are longer surgery times, treatment of renal calculi, surgeon inexperience, and previous irradiation. 1,3,7 Ureteral stents are the cornerstone in the management of ureteral injury. If stent placement is not possible following ureteral injury, placement of a percutaneous nephrostomy tube is required for renal drainage until elective repair can be accomplished. 1,[8][9][10] Several authors have reported reasonable rates of success with ureteroscopic ureteral realignment for iatrogenic ureteral injury during gynecologic and general surgical procedures.9-13 However, to our knowledge, there has not been a previous report of successful endoscopic ureteral realignment following avulsion of the ureter at the level of the ureteropelvic junction. Case reportA 59-year-old female with a long history of nephrolithiasis had a 7-mm right renal pelvic calculus. Ureteroscopic treatment was performed at an outside institution. There was some difficulty with ureteral dilatation and UPJ avulsion of the ureter was suspected associated with insertion of the ureteral access sheath. A safety guide wire was not used during the procedure. Subsequently, a guide wire was not able to be passed beyond the injury into the renal collecting system and, therefore, a stent could not be placed. A 5F ureteral catheter was placed through the avulsed proximal ureter projecting into the retroperitoneum. The patient was transferred to Indiana University Health Methodist Hospital for subsequent management.The patient has a history of cirrhosis, splenomegaly, and thrombocytopenia with a platelet count of 52,000 and an INR of 1.5. Ureteroscopy was performed confirming complete avulsion of the ureter (Fig. 1). A stent could not be placed and a ureteral catheter was replaced into the retroperitoneum near the kidney. The following day a percutaneous nephrostomy was inserted by Interventional Radiology (Fig. 2). The patient was then returned to the operating room and placed in a prone split-leg position to allow for simultaneous antegrade and retrograde access to the ureter. The percutaneous access was dilated to 30F and an Amplatz sheath was positioned into the kidney (Fig. 3). Nephroscopy identified the stone in the renal pelvis which was removed. The UPJ was identified and noted to be very small in caliber. A flexible ureteroscope was passed antegradely through the UPJ confirming that the avu...

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Endoscopic Rendezvous Procedure for Ureteral Iatrogenic Detachment: Report of a Case Series with Long-Term Outcomes

Abstract: The endoscopic rendezvous procedure reduces the need for invasive open surgical repair and represents the optimal initial option in patients with iatrogenic ureteral lesions before invasive procedures with higher morbidity are attempted.

Cited by 24 publications

References 16 publications

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

Evolution in the approach to overlooked ureteral injuries after gynecological surgery

Image-guided ureteral reconstruction using rendezvous technique for complex ureteric transection after gunshot injuries

Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

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