PMC5446609_01
Retrograde study confirming disruption to the course of the ureter with inability to place a guidewire into the kidney (A). A Double-J polymeric stent was inserted to preserve the patency of the mid and distal ureter (B).
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Ureteroscopic-guided attempts at insertion of a guidewire could not breach the entire ureteral defect; therefore, a 6F 26 cm ureteral stent was inserted to ensure that the ureteral lumen is preserved because the ureter was completely avulsed with no overlying mucosa (Fig. 1).
Contrast CT showing right ureteral disruption with retroperitoneal contrast extravasation (white arrow). The proximal ureteral stent is seen within the retroperitoneum (red arrow).
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An urgent nephrostomy was inserted by the interventional radiologist after an urgent CT urogram (Fig. 2).
Nephrostogram identifying the Double-J stent outside the course of the ureter (A) (arrow). Followed by effective rendezvous insertion of a Double-J polymeric stent across the ureteral defect (B).
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The patient and his family opted for endoscopic management, so on day 1 postoperatively, a combined antegrade/retrograde endoscopic repair (rendezvous procedure) was performed effectively, with insertion of an 8F 26 cm right-sided ureteral stent to bridge the segment of the avulsed ureter (Fig. 3).
Right ureteral Memokath stent bridging the strictured 4 cm segment of ureter that extends from the level of L4/L5 down to the level of the upper sacroiliac joint (A). A MAG 3 renogram with normal appearance and drainage of both kidneys. No evidence of obstruction seen (B).
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At 10 months after the original injury, a special-order 20 cm dual cone Memokath was effectively inserted (Fig. 4).