Abstract
The ureteric “rendezvous” procedure is an interventional procedure involving both uro-radiological and cystoscopic techniques to manage complex ureteric stenoses or fistulae. We present a case in which this procedure was utilised, with an unusual intra-procedural finding. Macroscopic visualisation of lipids within the urinary tract is an unusual finding at CT, and rarely seen at cystoscopy. The aetiology of lipiduria is varied; it may indicate the presence of unrecognised pathology, occur as a sequelae of trauma, or arise secondary to intervention. Understanding the patient's history is vital to determining the likely aetiology and significance of such a finding.
Highlights
Imaging findings Correlation with prior imaging revealed the presence of an intravesical fat-fluid level on CT carried out at 2 months post-operative, which had been overlooked in the report (Figure 2b,c)
Treatment: The “Rendezvous” Procedure Use of ureteric stents to maintain or restore ureteric patency is a well-documented and relatively common procedure for the management of both ureteric strictures and injuries, and indwelling ureteric stents are better tolerated than percutaneous nephrostomy.[1]
The uro-radiologist exchanges the patient’s nephrostomy (Figure 4a) for a selective catheter (4b) which is advanced to the proximal extent of the stricture under fluoroscopic guidance, whilst concurrently the distal ureter is accessed by ureteroscope (Figure 5a)
Summary
The combined uro-radiological “Rendezvous” procedure, and an unusual CT and cystoscopic finding. After failed attempts at antegrade stent insertion, temporising management was undertaken with nephrostomy, and the patient subsequently underwent cystoscopy as part of a combined endoscopic and uro-radiological rendezvous procedure to reinsert a ureteric stent. Imaging findings Correlation with prior imaging revealed the presence of an intravesical fat-fluid level on CT carried out at 2 months post-operative, which had been overlooked in the report (Figure 2b,c). This was not present in either the patient’s pre-operative or early postoperative CT imaging performed at day 8 (Figure 3a,b). Once the stricture has been crossed, dilators or a balloon catheter can be used to dilate to 9 French, allowing the placement of ureteric stent (Figure 6a,b).[1]
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