Abstract
Objective
To present the technique, feasibility and results of minimally-invasive reconstruction
of the transplanted ureter using the native ipsilateral ureter in post-transplant
ureteral strictures and vesicoureteral reflux (VUR) causing graft pyelonephritis.
Ureteral complications after kidney transplantation represent a significant cause
of morbidity potentially leading to graft dysfunction or loss.
Methods
A prospective database from October 2011 to August 2018 identified renal transplant
recipients who underwent minimally-invasive pyeloureterostomies or ureteroureterostomies
using the ipsilateral ureter. Indications for either transplant ureteral stricture
or VUR correction were assessed. Preoperative evaluation included a technetium-99m
mercaptoacetyltriglycine renal scan to assess residual native renal function and either
a video cysto-urethrogram or cystoscopy and retrograde pyelography. Postoperative
patency was evaluated with either cystograms or antegrade nephrograms in conjunction
with a technetium-99m mercaptoacetyltriglycine study.
Results
Seven patients were followed with a mean follow-up time of 20.9 months (range 4.7-64.8
months). Three cases of VUR causing graft pyelonephritis and 4 cases of transplant
ureteral stricture were identified. Five minimally-invasive transplant-to-native pyeloureterostomies
and 2 transplant-to-native ureteroureterostomies were performed. Six cases were performed
robotically and 1 laparoscopically. No recurrent episodes of pyelonephritis were observed
for patients treated for VUR causing graft pyelonephritis. Postoperative renal scans
and contrast studies demonstrated no evidence of obstruction or urinary leaks in all
cases.
Conclusion
Minimally-invasive reconstruction of the transplant ureter by pyeloureterostomy or
ureteroureterostomy using the ipsilateral native ureter is feasible and can be safely
performed with graft survival and acceptable complication rates.
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Article info
Publication history
Published online: January 14, 2019
Accepted:
January 8,
2019
Received:
September 11,
2018
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
