Percutaneous antegrade-retrograde recanalization (rendezvous technique) of a complete ureteropelvic junction...

Urinary fistula is a known complication of partial nephrectomy (PN), but complete disruption of the ureteropelvic junction (UPJ) is extremely rare. Surgical reconstruction in a post-operative field is challenging due to scarring and adhesions. We present a case of complete UPJ disruption following robotic-assisted partial nephrectomy (RAPN) that was successfully managed with a minimally invasive interventional radiology (IVR) technique. A 48-year-old female underwent RAPN for a 5.5 cm renal tumor in the right lower pole. Two months post-operatively, she developed a urinary fistula and was found to have a complete UPJ disruption. Due to the high risk associated with surgical revision, a combined antegrade-retrograde recanalization was planned in collaboration with interventional radiologists. Nine months after the initial surgery, under general anesthesia, a guidewire was advanced from the ureter and successfully punctured the renal pelvis under fluoroscopic guidance. The wire was captured in the renal pelvis using a snare and externalized through a pre-existing nephrostomy tract (rendezvous technique). A double-J stent was subsequently placed across the newly created tract. The patient has been followed for 2 years with regular stent exchanges every 6 months, and has maintained good renal function without evidence of hydronephrosis or recurrent fistula. A combined antegrade-retrograde IVR approach is a feasible and effective minimally invasive treatment for complete UPJ disruption following PN, particularly in cases where surgical reconstruction is deemed high-risk. At 2 years of follow-up, renal function has been fully preserved, demonstrating that this technique offers a valuable kidney-sparing alternative to nephrectomy.