Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries
Background: Complex ureteric strictures and injuries occurring during major abdominal and pelvic operations may cause significant morbidity and distress to patients. A rendezvous procedure is an endoscopic technique used in case of such injuries. Objective: To evaluate perioperative and long-term ou...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | European Urology Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168323000095 |
| _version_ | 1797900646899253248 |
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| author | Giorgio Mazzon Daron Smith Vimoshan Arumuham Giuseppe Celentano Marco Bolgeri Sian Allen Clare Allen Simon Choong |
| author_facet | Giorgio Mazzon Daron Smith Vimoshan Arumuham Giuseppe Celentano Marco Bolgeri Sian Allen Clare Allen Simon Choong |
| author_sort | Giorgio Mazzon |
| collection | DOAJ |
| description | Background: Complex ureteric strictures and injuries occurring during major abdominal and pelvic operations may cause significant morbidity and distress to patients. A rendezvous procedure is an endoscopic technique used in case of such injuries. Objective: To evaluate perioperative and long-term outcomes of rendezvous procedures to treat complex ureteric strictures and injuries. Design, setting, and participants: We retrospectively reviewed patients undergoing a rendezvous procedure for ureteric discontinuity including strictures and injuries, treated between 2003 and 2017 at our Institution and completing at least 12 mo of follow-up. We divided patients into two groups: early postsurgical obstruction, leakage, or detachment (group A) and late strictures (oncological/postsurgical; group B). Outcome measurements and statistical analysis: If appropriate, we performed a retrograde study ± rigid ureteroscopy to assess the stricture 3 mo after the rendezvous procedure, followed by a MAG3 renogram at 6 wk, 6 mo, and 12 mo, and annually thereafter for 5 yr. Results and limitations: Forty-three patients underwent a rendezvous procedure, 17 in group A (median age 50 yr, range 30–78) and 26 in group B (median age 60 yr, range: 28–83). Ureteric strictures and ureteric discontinuities were stented successfully in 15 out of 17 patients in group A (88.2%) and 22 out of 26 patients (84.6%) in group B. For both groups, the median follow-up was 6 yr. In group A, of 17 patients, 11 (64.7%) were stent free with no further interventions, two (11.7%) had a subsequent Memokath stent insertion (38%), and two (11.7%) required reconstruction. Of 26 patients in group B, eight (30.7%) required no further interventions and were stent free, ten (38.4%) were maintained with long-term stenting, and one was managed with a Memokath stent (3.8%). Of the 26 patients, only three (11.5%) required major reconstruction, while four patients with malignancy (15%) died during follow-up. Conclusions: With a combined antegrade and retrograde approach, the majority of complex ureteric strictures/injuries can be bridged and stented with an overall immediate technical success rate of above 80%, avoiding major surgery in unfavourable circumstances and allowing time for stabilisation and recovery of the patient. Additionally, in case of technical success, further interventions may be unnecessary in up to 64% of patients with acute injury and about 31% of patients with late stricture. Patient summary: The majority of complex ureteric strictures and injuries can be resolved using a rendezvous approach, avoiding major surgery in unfavourable circumstances. Moreover, this approach can help avoid further interventions in 64% of such patients. |
| first_indexed | 2024-04-10T08:49:18Z |
| format | Article |
| id | doaj.art-a4dc847bdc764409b96c2126cd9879b2 |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-04-10T08:49:18Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-a4dc847bdc764409b96c2126cd9879b22023-02-22T04:32:19ZengElsevierEuropean Urology Open Science2666-16832023-03-01495359Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and InjuriesGiorgio Mazzon0Daron Smith1Vimoshan Arumuham2Giuseppe Celentano3Marco Bolgeri4Sian Allen5Clare Allen6Simon Choong7Department of Urology, San Bassiano Hospital, Vicenza, ItalyInstitute of Urology, University College Hospital London, London, UKInstitute of Urology, University College Hospital London, London, UKDepartment of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy; Corresponding author. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80130 Naples, Italy. Tel. +39 081 7462611; Fax: +39 081 7462611.Department of Urology, St George's Hospital, London, UKInstitute of Urology, University College Hospital London, London, UKDepartment of Radiology, University College Hospital London, London, UKInstitute of Urology, University College Hospital London, London, UKBackground: Complex ureteric strictures and injuries occurring during major abdominal and pelvic operations may cause significant morbidity and distress to patients. A rendezvous procedure is an endoscopic technique used in case of such injuries. Objective: To evaluate perioperative and long-term outcomes of rendezvous procedures to treat complex ureteric strictures and injuries. Design, setting, and participants: We retrospectively reviewed patients undergoing a rendezvous procedure for ureteric discontinuity including strictures and injuries, treated between 2003 and 2017 at our Institution and completing at least 12 mo of follow-up. We divided patients into two groups: early postsurgical obstruction, leakage, or detachment (group A) and late strictures (oncological/postsurgical; group B). Outcome measurements and statistical analysis: If appropriate, we performed a retrograde study ± rigid ureteroscopy to assess the stricture 3 mo after the rendezvous procedure, followed by a MAG3 renogram at 6 wk, 6 mo, and 12 mo, and annually thereafter for 5 yr. Results and limitations: Forty-three patients underwent a rendezvous procedure, 17 in group A (median age 50 yr, range 30–78) and 26 in group B (median age 60 yr, range: 28–83). Ureteric strictures and ureteric discontinuities were stented successfully in 15 out of 17 patients in group A (88.2%) and 22 out of 26 patients (84.6%) in group B. For both groups, the median follow-up was 6 yr. In group A, of 17 patients, 11 (64.7%) were stent free with no further interventions, two (11.7%) had a subsequent Memokath stent insertion (38%), and two (11.7%) required reconstruction. Of 26 patients in group B, eight (30.7%) required no further interventions and were stent free, ten (38.4%) were maintained with long-term stenting, and one was managed with a Memokath stent (3.8%). Of the 26 patients, only three (11.5%) required major reconstruction, while four patients with malignancy (15%) died during follow-up. Conclusions: With a combined antegrade and retrograde approach, the majority of complex ureteric strictures/injuries can be bridged and stented with an overall immediate technical success rate of above 80%, avoiding major surgery in unfavourable circumstances and allowing time for stabilisation and recovery of the patient. Additionally, in case of technical success, further interventions may be unnecessary in up to 64% of patients with acute injury and about 31% of patients with late stricture. Patient summary: The majority of complex ureteric strictures and injuries can be resolved using a rendezvous approach, avoiding major surgery in unfavourable circumstances. Moreover, this approach can help avoid further interventions in 64% of such patients.http://www.sciencedirect.com/science/article/pii/S2666168323000095Iatrogenic injuryNephrostomyUreterUreteric stentUreteric stricture |
| spellingShingle | Giorgio Mazzon Daron Smith Vimoshan Arumuham Giuseppe Celentano Marco Bolgeri Sian Allen Clare Allen Simon Choong Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries European Urology Open Science Iatrogenic injury Nephrostomy Ureter Ureteric stent Ureteric stricture |
| title | Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries |
| title_full | Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries |
| title_fullStr | Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries |
| title_full_unstemmed | Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries |
| title_short | Long-term Outcomes of Minimally Invasive Rendezvous Procedures to Treat Complex Ureteric Strictures and Injuries |
| title_sort | long term outcomes of minimally invasive rendezvous procedures to treat complex ureteric strictures and injuries |
| topic | Iatrogenic injury Nephrostomy Ureter Ureteric stent Ureteric stricture |
| url | http://www.sciencedirect.com/science/article/pii/S2666168323000095 |
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