Rendezvous Technique: Step by Step

Abstract

Introduction: The treatment of complete ureteral stenosis varies depending on the severity and location of injury but can include ureteral stent placement and surgical repair. Long-term percutaneous nephrostomy (PN) drainage is another treatment option, but it leads to deterioration of the patient's quality of life. Therefore, as an alternative to surgery similar to ureteroureterostomy, the combined antegrade and retrograde approach, the so-called rendezvous technique, is required. Materials and Methods: A 52-year-old man with a history of prior flexible ureterorenoscopy for a 12 mm ureteral stone in the ureteropelvic junction presented with insidious onset complete ureteral stenosis. A nephrostomy tube was placed, and the patient was referred to our center. An anterograde and retrograde pyelography confirmed a diagnosis of ureteropelvic stenosis thought to be secondary to prior endoscopic procedure. A combined antegrade–retrograde rendezvous dilatation of stenosis was planned. A fiber-optic and digital ureteroscope were used through the left ureter and the nephrostomy tract, respectively, and allowed a careful visual examination of the ureteral lesion. The complete stenosis did not allow the passage of a 0.035″ Terumo guidewire. Transillumination and fluoroscopy were used to direct the retrograde lasering of the tissue to create the new ureteral path with thulium fiber laser technology. Laser settings were 1 J for pulsed energy and 5 Hz for pulsed frequency with short pulse. Results: After reaching the pelvis through the retrograde access, a Double-J ureteral catheter (8F) was placed to reduce the risk of restenosis and a nephrostomy tube. Laser time was 4 minutes and 38 seconds and total energy emitted was 1.39 KJ. The nephrostomy tube was removed after 48 hours. The procedure was well tolerated and after 3 days the patient was discharged with the Double-J. A retrograde pyelography was performed 1 month later showing contrast passage. Conclusions: Combined antegrade–retrograde rendezvous dilatation offers a safe and viable alternative to high-risk surgery in patients with complete ureteropelvic stenosis. A.S. and M.C. have nothing to disclose. O.T. is a consultant for Boston Scientific, Coloplast, EMS, IPG, Quanta and Rocamed, but has no specific conflicts relevant to this study. Runtime of video: 4 mins 46 secs Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.