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OBJECTIVE Ureteral necrosis is a rare complication of renal transplantation, and is seldom cured by endoscopic management alone. To avoid the potential hazard to the graft created by an open ureteral reconstruction in cases of renal transplant ureteral necrosis, we have appiled a new minimally invasive technique of total ureteral replacement, initially described for the palliative treatment of ureteral obstructions. The subcutaneous bypass technique is based on the use of a silicone-PTFE-bonded tube tunnelled underneath the skin. METHODS Total ureteral replacement by subcutaneous pyelovesical bypass was performed in three renal transplant patients (two men and one woman; mean age 41 years, (range 23-58) years with ureteral necrosis after failure of primary endoscopic treatment. The ureteral lesion was distal necrosis in two patients, and a total necrosis in the other. Under general anaesthesia and fluoroscopic guidance, a percutaneous tract was created and progressively dilated. The ureteral prosthesis was introduced into the pyelocaliceal cavities through a 30 F Amplatz sheet, then subcutaneously tracked down to the suprapubic area, and introduced into the bladder via a short incision. RESULTS There was no operative or postoperative morbidity. There was no obstruction, dislodgement or encrustation of the prosthesis. There were no bladder-related symptoms, or clinical reflux, and no abdominal wall complications. An asymptomatic episode of lower urinary tract infection (Staphylococcus epidermidis) was observed in the female patient. All the grafts were functioning with fine pyelocaliceal cavities, with a mean follow-up of 32 months (13-69 months). CONCLUSIONS Total ureteral replacement by subcutaneous pyelovesical bypass is a simple and safe technique of ureteral reconstruction in renal transplantation. Late encrustation of the prosthesis may occur, and the prosthesis may need to be changed in such cases. Subcutaneous pyelovesical bypass can be regarded as an alternative to an open procedure to treat ureteral necrosis after renal transplantation.
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
August 2011,
Journal of endourology,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
May 2021,
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
January 2008,
International urology and nephrology,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
January 1985,
Revista do Hospital das Clinicas,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
June 2010,
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
January 2017,
Central European journal of urology,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
April 1983,
The Journal of urology,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
March 2019,
Urology case reports,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
February 2007,
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie,
F Desgrandchamps, and
A Duboust, and
P Teillac, and
J M Idatte, and
A Le Duc
May 2012,
Pediatric transplantation,
