Two methodologies of the rendezvous procedure to establish ureteral continuity from a delayed ureteral leak following pelvic surgery. (March 2022)

• Record Type: Journal Article
• Authors: Sugarbaker, Paul H.; Sabri, Saher; Khan, Arshad A.; Aljundi, Moutasem N.; Chang, George
• Is Part Of: Surgical oncology. Volume 40(2022)
• Publication Date: 2022-03
• Subjects: Appendiceal mucinous neoplasms -- Ovarian cancer -- Ureteral stent -- Percutaneous nephrostomy -- Partial sacrectomy -- Ureteral trauma -- Ureteral necrosis -- Ureterolysis; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2021.101697
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: Ureteral trauma recognized in the operating theater is managed, for the most part, at the same surgical procedure oftentimes with urologic consultation. A delayed urine leak presents unique problems in that direct access to the site of the leak is not possible except by a reoperative procedure. Methods: In patients who develop delayed urine leakage following cancer surgery, the leakage may be controlled by the collaborative efforts of a urologist and interventional radiologist. Success depends on placement of a nephroureteral stent by the rendezvous procedure. Results: The sequence of procedures to reestablish ureteral continuity following a delayed leak are important in the successful placement of a nephroureteral stent. In the first methodology, through a percutaneous nephrostomy, a guidewire is placed in the ureter and down to the ureteral defect. The guidewire is then recovered and advanced into the bladder using a ureteroscope and grasping forceps. A nephroureteral stent is placed over the guidewire to bridge the gap and stent the ureteral defect. In the second methodology, the urologist passed a guidewire into the distal ureter, out of the ureteral defect, and into the free peritoneal space. Under fluoroscopic control, the wire loop must snare the ureteral guidewire and pull it out at the percutaneous nephrostomy. The nephroureteral stent is passed over the ureteral wire into the bladder. Conclusions: Two different methodologies were described to complete the rendezvous procedure. It can be successful a large percentage of the time with a delayed ureteral leakage. Success requires a combined interventional radiology and urologic procedure. Highlights: A successful rendezvous procedure avoids reoperative surgery. Collaboration of interventional radiologist and urologist are required. A ureteroscope may grasp a guidewire in the proximal ureter. Alternatively, a proximal wire loop snares a distal guidewire.