title: Combined antegrade and retrograde endoscopic retroperitoneal bypass of ureteric strictures: a modification of the 'rendezvous' procedure.
abstract: OBJECTIVE
  To evaluate our experience of treating complicated iatrogenic ureteric strictures with a combined antegrade and retrograde endoscopic retroperitoneal bypass technique, a modification of the so-called 'rendezvous' procedure.
  
  
  METHODS
  Seven patients presented to our institution between 2004 and 2008 after developing a complicated iatrogenic ureteric stricture, impassable with solitary antegrade or retrograde stenting techniques. In most cases there was a significant loss of ureteric continuity, with some strictures of up to 10-12 cm. After initial temporizing management with a percutaneous nephrostomy, each patient had a radiological 'rendezvous' procedure to insert a JJ stent and restore ureteric continuity. After 6 months, the JJ stents were removed and the patients evaluated by symptom assessment, serial measurements of serum creatinine and diuretic renography (F-15 mercaptoacetyl triglycine).
  
  
  RESULTS
  All seven 'rendezvous' procedures were successful and a ureteric stent was inserted across or around the stricture in all cases. Five of seven patients whose follow-up was >6 months had their stent removed successfully. At a median follow-up of 21 months, all patients are alive and none has required subsequent surgery. Six of the seven patients presented with significant symptoms and they are all currently symptom-free, which we consider to be a successful clinical outcome. No patient has developed significant renal impairment (estimated glomerular filtration rate (<30 mL/min) but we could only confirm successful unequivocal renographic drainage in one patient.
  
  
  CONCLUSIONS
  Combining antegrade radiological and retrograde endourological techniques, it is possible to restore ureteric continuity with a JJ stent, even in situations with extensive loss of the ureteric lumen. This reduces the need for morbid open surgical repair and offers a long-term solution to patients who might otherwise be consigned to less favourable conservative measures.
authors.affiliation: Department of Urology, Rotherham District General Hospital, Rotherham, South Yorks, UK. d.yates@sheffield.ac.uk
authors.forename: David R
authors.initials: DR
authors.lastname: Yates
authors.forename: Sampi S
authors.initials: SS
authors.lastname: Mehta
authors.forename: Paul A
authors.initials: PA
authors.lastname: Spencer
authors.forename: Bo T
authors.initials: BT
authors.lastname: Parys
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods* / Q000592:standards