Minimally-Invasive Ureteral Reconstruction for Ureteral Complications of Kidney Transplants. 2019

Kevin K Yang, and Alireza Moinzadeh, and Andrea Sorcini
Lahey Hospital & Medical Center, Burlington, MA. Electronic address: kevinyg@gmail.com.

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. 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. 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. 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.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011704 Pyelonephritis Inflammation of the KIDNEY involving the renal parenchyma (the NEPHRONS); KIDNEY PELVIS; and KIDNEY CALICES. It is characterized by ABDOMINAL PAIN; FEVER; NAUSEA; VOMITING; and occasionally DIARRHEA. Necrotizing Pyelonephritis,Pyelonephritis, Acute Necrotizing,Pyelonephritides
D005240 Feasibility Studies Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project. Feasibility Study,Studies, Feasibility,Study, Feasibility
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D013520 Urologic Surgical Procedures Surgery performed on the urinary tract or its parts in the male or female. For surgery of the male genitalia, UROLOGIC SURGICAL PROCEDURES, MALE is available. Procedure, Urologic Surgical,Procedures, Urologic Surgical,Surgical Procedure, Urologic,Surgical Procedures, Urologic,Urologic Surgical Procedure,Urological Surgical Procedures,Procedure, Urological Surgical,Procedures, Urological Surgical,Surgical Procedure, Urological,Surgical Procedures, Urological,Urological Surgical Procedure

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