Garvey Christopher, Rohan Pat, Motyer Ronan, Courtney Michael, Ryan J Mark
Department of Interventional Radiology, St. James's Hospital, Dublin, Ireland.
Department of Interventional Radiology, Beaumont Hospital, Dublin, Ireland.
J Surg Case Rep. 2022 Nov 8;2022(11):rjac465. doi: 10.1093/jscr/rjac465. eCollection 2022 Nov.
A 46-year-old female underwent elective laparoscopic hysterectomy. Seven days post-operatively, she presented with urinary leak from the vagina. Computed tomography urogram demonstrated a right complete ureteric transection with leakage of urine into the pelvis and fistulation into the vagina. A rendezvous procedure was performed via a retrograde cystoscopic approach during which a guidewire was used to cannulate the right ureteric orifice and coiled in the retroperitoneal cavity. Subsequently, via a right percutaneous nephrostomy, a guidewire was advanced through the site of ureteric transection, which was followed by a snare catheter to bring the retrograde wire externally. A nephroureteric stent was then inserted. Twelve weeks later, the nephroureteric stent was exchanged for a ureteric stent for 6 months. A subsequent retrograde ureterogram showed complete healing of the ureter. The ureteric stent was removed and follow-up ultrasounds revealed no hydronephrosis. Percutaneous rendezvous procedures represent an effective option to treat this challenging condition.
一名46岁女性接受了择期腹腔镜子宫切除术。术后七天，她出现阴道漏尿。计算机断层扫描尿路造影显示右侧输尿管完全横断，尿液漏入盆腔并形成通向阴道的瘘管。通过逆行膀胱镜检查进行了会师手术，在此过程中使用导丝插入右侧输尿管口并盘绕在腹膜后腔。随后，通过右侧经皮肾造瘘术，将导丝推进至输尿管横断部位，随后使用圈套导管将逆行导丝引出体外。然后插入了输尿管肾支架。十二周后，将输尿管肾支架更换为输尿管支架，持续6个月。随后的逆行输尿管造影显示输尿管完全愈合。取出输尿管支架，后续超声检查未发现肾积水。经皮会师手术是治疗这种具有挑战性的病症的有效选择。
