Nephroureterectomy, renal autotransplantation, and pyelocystostomy have been performed in eight patients with urothelial tumors of the upper urinary tract. One patient had tumors in a solitary kidney, two patients had bilateral tumors, and five patients had unilateral tumors. Three patients have had recurrent calyceal tumors which were successively managed by the transurethral route. In one patient the kidney had to be removed after 4.5 years because of infiltrating tumor recurrence. Two patients died; the renal pelvis of the graft was tumor free at autopsy in both cases. The other five patients are alive and free from tumor recurrence. The procedure implies increased radicality compared with conventional conservative treatment and simplified follow‐up. It may be considered in patients with bilateral tumors or tumors of a solarity kidney, and in selected patients with unilateral low‐grade, low‐stage tumors.
A total of 4 patients with persistent outflow obstruction after pyeloplasty for hydronephrosis was reoperated with renal autotransplantation and pyelocystostomy. All 4 patients had undergone an unsuccessful Anderson-Hynes pyeloplasty and 2 also had had a second operation. All patients had relief of pain, normalization of urine outflow and improved renal function during an observation of 27 to 37 months. Occasional asymptomatic bacteriuria occurred in 2 patients. Thus, renal autotransplantation and pyelocystostomy may be considered a useful and safe method to eliminate persistent outflow obstruction after unsuccessful pyeloplasty.
The urodynamic consequences of renal autotransplantation and pyelocystostomy were studied in 17 male and 3 female patients. The indications of the procedure were urothelial tumor of the upper urinary tract, remaining outflow obstruction after conventional pyeloplasty and recurrent stones. The mean observation time was 31 months (range 3–50 months). The micturition flow rate was unchanged. There was an insignificant increase in residual urine. No evidence of any clinically significant disturbance of the sensory or motor bladder innervation or reduction of the functional bladder capacity was found. Urethrocystography showed transient dilatation of calyces at micturition. Urinary tract infections, when present, had the same pattern as preoperatively. Thus, autotransplantation of the kidney with a wide, direct pyelocystostomy is consistent with essentially normal urodynamics of the transplanted renal pelvis and the bladder.
Six male patients with severe recurrent urinary calculus disease underwent renal autotransplantation with direct pyelocystostomy to allow spontaneous passage of stones. The only serious complication was an early renal vascular thrombosis with graft loss in one patient who had been operated on three times before with ipsilateral partial resections for nephrolithiasis. The other five patients did well (observation time 4-34 months). Their renal function has remained unchanged. Autotransplantation with direct pyelocystostomy should be considered in patients with multiple recurrent stones of the upper urinary tract, especially when some degree of obstruction has developed or when other predisposing anomalies prevail.
The function of 20 human autologous kidney grafts was studied for 4 to 8 years (mean 5 1/2) after autotransplantation with a direct pyelocystostomy. The indications for the operation were low-grade, low-stage tumour of the renal pelvis and/or ureter, frequently recurrent renal stones and remaining outflow obstruction after pyeloplasty for hydronephrosis. The wide pyelocystostomy implies reflux of urine from the urinary bladder to the renal pelvis but no significant changes were found in glomerular or tubular function, studied with 51Cr-EDTA clearance, 131I-Hippuran renography, analysis of beta 2-microglobulin and total protein excretion in urine, and determination of concentration ability after administration of desmopressin. No increase in the severity or frequency of urinary tract infections was observed.
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