PD40-11 Trends and Predictors of Ureteral Injuries in the Era of Laparoscopic and Robotic Surgery (original) (raw)

2016, The Journal of Urology

to externalise it. Adequate tension can then be applied to straighten the ureter to aid placement of a stent. METHODS: We retrospectively reviewed patients undergoing a Rendezvous procedure for ureteric discontinuities, treated between 2005 and 2014 at our Institution and completing at least a 12 monthfollow up. We divided patients into two groups: late oncological/postsurgical stricture (group A), or early post-surgical obstruction, leakage or detachment (group B). If appropriate, we performed a retrograde study +/-rigid ureteroscopy to assess the stricture after 3 month from the procedure, followed by a MAG3 renogram at 6 and 12 months. RESULTS: 32 patients underwent a Rendezvous procedure, 22 in group A (Mean age 59.35, range: 49-74), 10 in group B (Mean age 52.44, range: 36-63). Strictures were successfully stented in 18 out of 22 patient (82%) in the group A, 7 out of 10 in group B (70%). After successful stenting, at 12 month 9/18 of group A required no further interventions and were stent free (50%), 5 (28%) were maintained with long term stenting. Only 2 (11%) required major reconstruction, 2 patients (11%) died during follow up from malignancy. In group B, 4/8 (50%) were stent free with no further interventions, 3/ 8 (38%) were maintained on long term stenting, only 1 required reconstruction. CONCLUSIONS: With a combined antegrade and retrograde approach, the majority of complex ureteric stricture can be bridged and stented, avoiding major surgery in unfavourable circumstances and allows time for stabilisation and recovery of the patient. Interestingly, if successful, further interventions later may be unnecessary in up to 50% of patients. This is particularly useful in elderly patients with malignant stricture, but also in young patients with benign discontinuities and a good blood supply to the ureter.