Two methodologies of the rendezvous procedure to establish ureteral continuity from a delayed ureteral leak following pelvic surgery

Surg Oncol. 2022 Mar;40:101697. doi: 10.1016/j.suronc.2021.101697. Epub 2022 Jan 7.

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.

Keywords: Appendiceal mucinous neoplasms; Ovarian cancer; Partial sacrectomy; Percutaneous nephrostomy; Ureteral necrosis; Ureteral stent; Ureteral trauma; Ureterolysis.

MeSH terms

  • Humans
  • Neoplasms / surgery*
  • Nephrostomy, Percutaneous / methods*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery*
  • Reoperation
  • Stents
  • Ureter / injuries*
  • Ureteroscopy / methods*
  • Urinary Catheterization / methods*
  • Urine