Urinary tract reconstruction using the controlateral native ureter and a combined open‐retroperitoneoscopic approach after renal transplantation

Orlando, Giuseppe; Clemente, Luigi Di; Gravante, Gianpiero; Overton, John D.; Cocco, Pierpaolo Di; Rizza, V.; D’Angelo, M.; Famulari, A.; Pisani, F.

doi:10.1111/j.1399-0012.2008.00883.x

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…9 Their technique entailed retroperitoneoscopic preparation of the native ureter contralateral to the renal graft, followed by an open anastomosis to the transplant ureter through the Retzius space. 9 Retroperitoneoscopic preparation allows for surgery with high precision; however, in our case, an open approach with tunneling under the sigmoid was preferred because of the patient's complex anatomy.…”

Section: Discussionmentioning

confidence: 99%

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

Barański²

2019

Exp Clin Transplant

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The decision-making process for treatment of patients with end-stage renal failure, multiple failed renal transplants, and severe comorbidities can be exceedingly difficult due to the inapplicability of many common surgery methods. In this article, we report the treatment of such a patient who underwent a third renal transplant and subsequently developed a ureteral stenosis. The third kidney had been transplanted with a high abdominal position and a partially intra-and retroperitoneally placed ureter due to a bilaterally obtained iliac fossa and severe abdominal adhesions. For the severe ureteric stenosis, an alternative urinary tract reconstruction was developed by making use of the native ureter contralateral to the graft by tunneling under the sigmoid. We recommend this surgical method as a valid alternative for patients with severe ureteric graft stenosis, when treatment with stenting and common surgical ureter reconstruction methods are not feasible. Key words: Complex receptor, Constriction, End-stage renal disease, Orthotopic, Pathologic, Ureter IntroductionThe decision-making process to treat patients with end-stage renal disease and an extensive medical background, including multiple failed transplants and severe comorbidities, can be extremely difficult. In this article, we report the surgical treatment of such a patient who underwent a third renal transplant procedure and subsequently developed a ureter stenosis of the transplanted kidney.A common problem with multiple previous renal transplants is a bilaterally unavailable iliac fossa, making heterotopic transplant sometimes not suitable. In such cases, an orthotopic transplant is an alternative approach. Functional results, that is, patient and graft survival rates at 1, 10, and 20 years, are almost similar to heterotopic transplant procedures. However, the technique is challenging, and the complication rate is slightly higher than with iliac vessel heterotopic transplants. 1,2The major complications in renal transplant recipients are urologic problems in the posttransplant period, occurring with an incidence of around 3%, of which ureteric stenosis represents 25% to 30%. [3][4][5][6] The optimal surgical approach for reconstruction of such ureteric stenosis depends on the stricture's section. Because common surgical approaches or a fourth transplant are not always optimal, as for our present complicated case, an alternative approach for urinary tract reconstruction by anastomosis to the contralateral native ureter was developed. 6Case Report patient history A 22-year-old man was admitted to the hospital for a third transplant due to end-stage renal failure. His medical history included premature birth with perinatal asphyxia, spastic tetraplegia, mild mental retardation, and severe vertebral column scoliosis. He developed end-stage renal failure by perinatal asphyxia and dysplasia of the kidneys and a neuropathic bladder by tetraplegia. As a result of continuous infectious diseases, he received nephrectomy of both kidneys, without the remov...

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Section: Discussionmentioning

confidence: 99%

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

Barański²

2019

Exp Clin Transplant

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Methods of Treatment of Surgical Complications After Kidney Transplantation

Barański

2023

Kidney Transplantation

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Successful urinary tract reconstruction following ureteral necrosis in kidney transplant patient

Piros

Deák

Dallos

et al. 2010

IMAS

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Ureteric complications following renal transplantation are well known to cause significant morbidity and compromised graft survival. The necrosis of a major part of the ureter could be a highly detrimental situation, and hardly solvable complication, that poses great challenges. Herein we are presenting a case report to introduce a possible surgical solution following repeated ineffective radiological interventions, in a patient with ureteric necrosis that appeared 3 months after cadaveric kidney transplantation. We transplanted the right kidney to the right iliac fossa performing end-to-side vascular anastomoses and end-to-side uretero-ureterostomy. His clinical course was uneventful during 3 months, when he presented a mild borderline acute cellular rejection together with dilatation of the pyelon. Percutaneous nephrostomy was performed by interventional radiologist. During further radiologic interventions the stenosis was not permeable. We finally made up our minds for surgical solution. We found a totally necrotized graftureter. During a second operation we performed a right nephrectomy, transsecting the pyelon. After mobilization of the transplanted kidney approaching and identifying the pyelon, a large pyelopyelar anastomosis was performed with stenting. The postoperative follow-up showed excellent urine flow from the kidney to the bladder, then the TRD was removed. Surgery had to be considered only if minimally invasive procedures are infeasible or ineffective. A regimen of reconstructive methods are well-known, but all cases have to be evaluated individually. If the native kidneys can be removed, their pyelons and entire ureters should be used for reconstruction.

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Urinary tract reconstruction using the controlateral native ureter and a combined open‐retroperitoneoscopic approach after renal transplantation

Cited by 3 publications

References 15 publications

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

Methods of Treatment of Surgical Complications After Kidney Transplantation

Successful urinary tract reconstruction following ureteral necrosis in kidney transplant patient

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