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

Abstract

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...