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Thillou D, Timsit MO, Panthier F, Hurel S, Amrouche L, Anglicheau D, Méjean A, Audenet F. End-to-side versus end-to-end uretero-ureteral anastomosis in preemptive kidney transplantation from living donors: A monocentric experience. Prog Urol 2023; 33:118-124. [PMID: 36774268 DOI: 10.1016/j.purol.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE End-to-end (ETE) pyeloureterostomy is an alternative to ureteroneocystostomy for urinary anastomosis during kidney transplantation (KT). In preemptive KT from living donors (PKT-LD), end-to-side (ETS) uretero-ureteral anastomosis could have the benefits of pyeloureterostomy without ligation of the native kidney ureter. This study aimed to compare ETS to ETE uretero-ureteral anastomosis in PKT-LD. METHODS A monocentric retrospective 8-year study included all consecutive cases of PKT-LD, excluding ureteroneocystomy anastomosis and homolateral nephrectomy. Two groups were compared: ETS and ETE. Perioperative data on graft function and urological complications were collected. RESULTS One hundred and six patients were included: 48 patients in the ETS group and 58 patients in the ETE group. Median follow-up was 37.5 months [17.3; 57.5]. The estimated glomerular filtration rate at postoperative day ten and 3 months was similar in both groups. The overall complication rate was 16%, with no significant difference between the 2 groups. There was one ureteral stenosis in each group. None of the patients in the ETS group presented urinary fistula, whereas it occurred in one (1.7%) in the ETE group. Back pain due to native kidney obstruction occurred in 5 patients in the ETE group (8.6%), but not in the ETS group. CONCLUSION In preemptive kidney transplantation from living donors, urinary anastomosis can safely be performed as an end-to-side uretero-ureteral anastomosis, with low urological complications. It could prevent symptoms and complications due to native kidney obstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- D Thillou
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - F Panthier
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - S Hurel
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - L Amrouche
- Department of Nephrology and Kidney Transplantation, Hôpital Necker, AP-HP, Centre-Université Paris Cité, France
| | - D Anglicheau
- Department of Nephrology and Kidney Transplantation, Hôpital Necker, AP-HP, Centre-Université Paris Cité, France
| | - A Méjean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - F Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France.
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Neto HM, Tedesco Silva Junior H, Pestana JM, Foresto RD, Aguiar WF. Urological Complications Associated With Pyeloureterostomy Without Ipsilateral Nephrectomy in Renal Transplant Recipients. Transpl Int 2022; 35:10213. [PMID: 35185371 PMCID: PMC8842274 DOI: 10.3389/ti.2021.10213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/15/2021] [Indexed: 12/04/2022]
Abstract
Background: The implications of ligating the native ureter without ipsilateral nephrectomy after primary kidney transplant pyeloureterostomy (PU) have been described previously. Methods: This single-center retrospective cohort study including 4,215 kidney transplants performed between February 2010 and December 2014, analyzed urological complications following primary (P-PU) and secondary (S-PU) pyeloureterostomy used to treat urological leaks (UL-PU) and ureteral stenosis (US-PU) without concomitant ipsilateral nephrectomy, in a large cohort of patients. Results: There were 495 (11.7%) pyeloureterostomy with native ureter ligation without nephrectomy, 409 P-PU (82.6%) and 86 S-PU (17.4%), of which 76 were UL-PU and 10 were US-PU. The median follow-up was 33.8 months. The incidence of native ipsilateral kidney complications requiring nephrectomy was 2.02% (n = 10). Urinary leak was diagnosed in 3.6% of patients after P-UP and 9.2% after UL-PU. Ureteral stenosis was diagnosed in 1.7% of patients after P-UP, 3.9% after UL-PU and 10% after US-PU. Conclusion: This cohort analysis suggests that native ureter ligation during pyeloureterostomy without native nephrectomy is associated with low incidence of clinically indicated ipsilateral native nephrectomy. Caution and awareness should be emphasized in patients with history of ADPKD and neurogenic augmented bladders.
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Affiliation(s)
- Hernani M. Neto
- Department of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil
- Hospital do Rim (HRim), Sao Paulo, Brazil
| | - Helio Tedesco Silva Junior
- Hospital do Rim (HRim), Sao Paulo, Brazil
- Department of Nephrology, Federal University of Sao Paulo, Sao Paulo, Brazil
- *Correspondence: Helio Tedesco Silva Junior,
| | - José M. Pestana
- Hospital do Rim (HRim), Sao Paulo, Brazil
- Department of Nephrology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Wilson F. Aguiar
- Department of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil
- Hospital do Rim (HRim), Sao Paulo, Brazil
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Yang KK, Moinzadeh A, Sorcini A. Minimally-Invasive Ureteral Reconstruction for Ureteral Complications of Kidney Transplants. Urology 2019; 126:227-231. [DOI: 10.1016/j.urology.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/06/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
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Canning DA. Re: Laparoscopic Ureteral Ligation (Clipping): A Novel, Simple Procedure for Pediatric Urinary Incontinence Due to Ectopic Ureters Associated with Non-Functioning Upper Pole Renal Moieties. J Urol 2015; 195:168. [PMID: 26699989 DOI: 10.1016/j.juro.2015.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Romao RLP, Figueroa V, Salle JLP, Koyle MA, Bägli DJ, Lorenzo AJ. Laparoscopic ureteral ligation (clipping): a novel, simple procedure for pediatric urinary incontinence due to ectopic ureters associated with non-functioning upper pole renal moieties. J Pediatr Urol 2014; 10:1089-94. [PMID: 24881807 DOI: 10.1016/j.jpurol.2014.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 04/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A simplified approach for the surgical management of symptomatic ectopic ureters, associated with a non-functioning upper moiety, with laparoscopic ureteric clipping is presented in this research paper. MATERIALS AND METHODS Prospectively collected data on nine consecutive girls with ectopic ureters associated with urinary incontinence who underwent laparoscopic clipping between February 2011 and December 2013. Surgical technique consisted of cystoscopy and insertion of ureteral catheter in the lower pole ureter to aid in identification and clipping of the ectopic ureter, which was achieved by standard trans-peritoneal laparoscopy. RESULTS Median age was eight years (range 4-17 years). Diagnosis was based on clinical findings, which were supported by: ultrasound (US), nuclear scans and magnetic resonance urography in Cases 9, 8 and 5, respectively. Bilateral complete duplication was present in two patients; the combination of cystoscopy and laparoscopy allowed adequate identification of the ectopic ureter causing incontinence in both. All nine patients were immediately dry after surgery and remain asymptomatic after a maximum follow up of 27 months. Eight out of nine patients had developed some degree of asymptomatic upper pole hydronephrosis on follow-up US. CONCLUSION Laparoscopic clipping holds promise as a simple alternative to other more-complex surgical procedures in the treatment of incontinence due to an ectopic ureter. Despite favorable and encouraging initial results, further follow up is warranted in order to determine the fate of expected associated upper-pole hydronephrosis.
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Affiliation(s)
- R L P Romao
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; Division of Urology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - V Figueroa
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - J L Pippi Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - D J Bägli
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - A J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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Riediger C, Müller MW, Bachmann J, Novotny A, Thorban S, Matevossian E, Friess H, Stangl M. Native ureteropyelostomy: an effective therapy for urinary tract complications following kidney transplantation. ANZ J Surg 2014; 84:643-8. [DOI: 10.1111/ans.12526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Carina Riediger
- Department of Surgery; Technische Universität München; Munich Germany
| | - Michael W. Müller
- Department of Surgery; Technische Universität München; Munich Germany
- Department of Surgery; Klinikum Stuttgart, Clinical Center Bad Cannstatt; Stuttgart Germany
| | - Jeannine Bachmann
- Department of Surgery; Technische Universität München; Munich Germany
| | - Alexander Novotny
- Department of Surgery; Technische Universität München; Munich Germany
| | - Stefan Thorban
- Department of Surgery; Technische Universität München; Munich Germany
| | | | - Helmut Friess
- Department of Surgery; Technische Universität München; Munich Germany
| | - Manfred Stangl
- Department of Surgery; Technische Universität München; Munich Germany
- Department of Surgery; Ludwig Maximilian's University; Munich Germany
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Intravesical ligation as a new technique to manage a refluxing native ureter without simultaneous nephrectomy in renal transplantation. Transplant Proc 2012. [PMID: 23195002 DOI: 10.1016/j.transproceed.2012.03.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This article aims to describe an original technique to correct refluxing native ureters observed during a prerenal transplantation study. The correction is performed by intravesical ligation of the native refluxing ureters at the same time as renal transplantation without simultaneous nephrectomy. METHODS Between January 2004 and December 2010 we performed intravesical ligation of a refluxing ureter simultaneous with a transplantation procedure without a concomittant native nephrectomy in 12 of 345 subjects (3.47%). The 8 bilateral and 4 unilateral ligations were performed on 11 cadaveric and 1 living-related nonidentical donor transplantations. The implantation of the kidney donor ureter was performed anatomically in the bladder trigone through a transvesical ureteroneocystostomy with a transmural, submucosal antireflux tunnel. RESULTS Early and late postoperative recovery was satisfactory in all patients. There was no documented kidney area pain, proven urinary tract infection, morbidity or mortality attributed to the procedure. CONCLUSIONS Intravesical ligation is a practical technique to manage vesicoureteral reflux into the native ureters simultaneously with the ureteral implantation of the kidney donor in a single surgical renal transplant procedure without native kidney nephrectomy.
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Goh BKP, Dean PG, Cosio FG, Gloor JM, Prieto M, Stegall MD. Bilateral native ureteral ligation without nephrectomy in the management of kidney transplant recipients with native proteinuria. Am J Transplant 2011; 11:2747-50. [PMID: 21883918 DOI: 10.1111/j.1600-6143.2011.03721.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aim of this study was to assess the safety of bilateral native ureteral ligation (BNUL) without nephrectomy in the management of native proteinuria in kidney transplant (KTx) recipients. We retrospectively studied 17 patients who underwent BNUL between 2002 and 2010 with a median preoperative 24 h protein concentration of 2140 (range 1020-25 000) mg/L. Fifteen of the 17 patients had focal segmental glomerulosclerosis as their primary renal disease and ligation was employed to facilitate the diagnosis of early recurrence. The BNUL was performed simultaneously with KTx in 14 patients. Surgical techniques were: open (n = 5), pure laparoscopic (n = 1) and a hybrid of hand-assisted laparoscopic surgical/open approach (n = 12) used at the time of transplantation via the transplant incision. At a median follow-up of 46 months (range 1-59), no patient had a complication related to BNUL and none required interventions associated with their native kidneys. BNUL without nephrectomy seems to be a safe technique to manage native proteinuria in renal transplant candidates.
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Affiliation(s)
- B K P Goh
- The William J. von Liebig Transplant Center, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA
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Timsit MO, Lalloué F, Bayramov A, Taylor M, Billaut C, Legendre C, Kreis H, Badet L, Méjean A. Should Routine Pyeloureterostomy be Advocated in Adult Kidney Transplantation? A Prospective Study of 283 Recipients. J Urol 2010; 184:2043-8. [DOI: 10.1016/j.juro.2010.06.144] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Marc-Olivier Timsit
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanny Lalloué
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France
| | - Araz Bayramov
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France
| | - Melissa Taylor
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
| | - Claire Billaut
- Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Henri Kreis
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Badet
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France
| | - Arnaud Méjean
- Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Orlando G, Di Clemente L, Gravante G, Overton J, Di Cocco P, Rizza V, D'Angelo M, Famulari A, Pisani F. Urinary tract reconstruction using the controlateral native ureter and a combined open-retroperitoneoscopic approach after renal transplantation. Clin Transplant 2008; 22:842-6. [PMID: 18713262 DOI: 10.1111/j.1399-0012.2008.00883.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An alternative technique for urinary tract (UT) reconstruction is described in a renal transplant recipient who developed a severe stenosis of the graft ureter. This approach entails the retroperitoneoscopic preparation of the native ureter contralateral to the graft, followed by an open reconstruction of the UT. The ureter was dissected along its entire length to the level of the iliac vessels, with its associated mesentery still attached in order to preserve the vascular supply. The corresponding native kidney contralateral to the graft was endoscopically removed. A longitudinal sub-umbilical incision allowed the excision of the stenotic tract and the reconstruction of the UT by means of a manual end-to-end anastomosis between the new ureter and the graft pelvis. No post-operative complications occurred and renal function immediately resumed. The approach described represents an alternative solution for the surgical management of severe ureteric graft stenosis. We believe that the magnification of the anatomy granted by the endoscope during the dissection of the ureter and neighboring structures provides the gentle handling of the tissues and the remote dissection away from the ureter with the highest precision.
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Affiliation(s)
- Giuseppe Orlando
- Transplant and Renal Failure Unit, Department of Surgery, University of L'Aquila, L'Aquila, Italy.
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Kamali K, Zargar MA, Zargar H. Early common surgical complications in 1500 kidney transplantations. Transplant Proc 2003; 35:2655-6. [PMID: 14612058 DOI: 10.1016/j.transproceed.2003.09.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K Kamali
- Department of Urology and Transplantation, Hashemi Nejad Hospital, Tehran, Iran.
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LIGATION OF THE NATIVE URETER IN RENAL TRANSPLANTATION. J Urol 2002. [DOI: 10.1097/00005392-200201000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- MICHAEL L. GALLENTINE
- From the Department of Urology, Wilford Hall Medical Center and Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, Texas
| | - FRANCIS H. WRIGHT
- From the Department of Urology, Wilford Hall Medical Center and Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, Texas
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Schult M, Küster J, Kliem V, Brunkhorst R, Nashan B, Oldhafer KJ, Schlitt HJ. Native pyeloureterostomy after kidney transplantation: experience in 48 cases. Transpl Int 2000. [DOI: 10.1111/j.1432-2277.2000.tb01007.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Salomon L, Saporta F, Amsellem D, Hozneck A, Colombel M, Patard JJ, Chopin D, Abbou CC. Results of pyeloureterostomy after ureterovesical anastomosis complications in renal transplantation. Urology 1999; 53:908-12. [PMID: 10223482 DOI: 10.1016/s0090-4295(98)00624-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The most frequent urologic complications after renal transplantation involve the ureterovesical anastomosis (ie, leakage, stenosis, and reflux), with a frequency of 1% to 30% in different series. We present the results of pyeloureterostomy using the recipient's ureter. METHODS From 1988 to 1996, 570 cadaveric renal grafts were performed at our institution. A Lich Gregoir ureterovesical anastomosis was used in every case. Complications involving the anastomosis occurred in 19 cases (3.3%), with 10 stenoses (1.7%), 6 cases of leakage (1.1%), and 3 of reflux (0.5%). The mean donor age was 36.2 years, and the mean duration of cold ischemia was 29.4 hours. The mean recipient age was 41.3 years. Corrective surgery was performed 0.09 years (range 0.01 to 0.22) after transplantation for leakage, 1.13 years (range 0.14 to 5.11) for stenosis, and 5.55 years (range 0.51 to 9.71) for reflux. The recipient's ureter was stented with a ureteral catheter before median laparotomy, except in 3 cases of early leakage (less than 3 days). The recipient's ureter was cut, without the need for ipsilateral nephrectomy, and sutured to the graft pelvis. A nephroureterostomia stent (Gil Vernet stent) (12 cases) or a double J ureteral stent (7 cases) was used for urinary drainage. RESULTS One graft was lost on day 1 through renal vein thrombosis. Percutaneous nephrostomy was performed on day 2 to clear an obstruction of the double J ureteral stent in one case, and a double J ureteral stent was inserted on day 2 because the nephrouretrostomia stent was incorrectly positioned in another case. Pyelographic controls on day 15 were normal in every case. The mean follow-up was 2.25 years (range 0.24 to 6.1) (2.9 years for leakage, 2.08 years for stenosis, and 1.44 years for reflux). One patient died with a functional graft 3 years after surgery. One graft was lost 4 years after surgery through chronic rejection. There were no complications affecting the ipsilateral kidney. No further ureteral complications occurred after surgery. The mean creatinine level 3 years after surgery was 1.59 mg/dL. CONCLUSIONS Pyeloureterostomy is a safe and permanent treatment for complications of ureterovesical anastomosis and gives excellent results. The technique requires stenting of the recipient's ureter and graft drainage with a nephroureterostomia stent or a double J ureteral stent.
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Affiliation(s)
- L Salomon
- Service de Chirurgie Urologique, Hospital Henri Mondor, Créteil, France
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Kockelbergh RC, Millar RJ, Walker RG, Francis DM. Pyeloureterostomy in the management of renal allograft ureteral complications: an alternative technique. J Urol 1993; 149:366-8. [PMID: 8426422 DOI: 10.1016/s0022-5347(17)36085-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Pyeloureterostomy is the standard procedure for reconstructing renal allograft ureteral complications. Most reports describe an end-to-end technique with or without native nephrectomy. An alternative is an end-to-side anastomosis, leaving the native ureter in continuity. We report our experience with the latter method. Since July 1983, 437 renal transplantations have been performed at our institution. End-to-side pyeloureterostomy has been used in 5 cases for urological reconstruction after renal transplantation following ureteral ischemic necrosis or stenosis. In 1 patient the native kidneys had been removed several years previously but in the remaining 4 the native kidneys were left in situ. There have been no significant complications following this procedure. We believe that by not significantly mobilizing, ligating or dividing the native ureter the chance of anastomotic breakdown due to ischemia may be decreased.
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Affiliation(s)
- R C Kockelbergh
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Lord RH, Pepera T, Williams G. Ureteroureterostomy and pyeloureterostomy without native nephrectomy in renal transplantation. BRITISH JOURNAL OF UROLOGY 1991; 67:349-51. [PMID: 2032072 DOI: 10.1111/j.1464-410x.1991.tb15159.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A series of 23 patients, receiving full immunosuppression following renal transplantation, underwent a uretero- or pyelo-ureterostomy with ligation of the native ureter and no nephrectomy. In 5 patients this was carried out at the time of transplantation because of a short donor ureter and in 18 patients, at a median of 47 days after transplantation, following ureteric complications. With a median follow-up of 22 months, no complications have been seen in relation to the native kidney. Ureteroureterostomy was successful in all but 3 patients. A ureteroureterostomy without native nephrectomy is a safe and effective treatment for the management of ureteric complications following renal transplantation.
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Affiliation(s)
- R H Lord
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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Hickey DP, Glacken P, Gawley W, Carey J, Mulcahy M, McLean PA Hanson JS, Hanson JS, Murphy DM. Urological complications in 454 renal transplants. Ir J Med Sci 1988; 157:222-5. [PMID: 3049435 DOI: 10.1007/bf02949305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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