Kidney Transplant Grafts With Complete Ureteral Duplication

Abstract

Objectives: To evaluate the outcome of renal transplants using donor grafts with complete ureteral duplication. Materials and Methods: Between 1999 and 2011, we performed 1368 kidney transplant procedures, including 87 dual kidney transplants. There were 12 transplants with donor kidneys that had complete ureteral duplication, including 2 patients who had grafts with ureteral duplication that were used to perform a dual kidney transplant. In 11 patients with ureteral duplication, the 2 ureters were anastomosed separately to the bladder with a double Lich-Gregoir technique; in 1 patient, a ureteroureteral terminolateral anastomosis and single ureteroneocystostomy were performed. Results: Urinary tract infections were noted during the first year after transplant in 7 patients (58%) that had kidney grafts with duplicated ureters (4 patients with 1 infection each; 3 patients with 2 infections each), but none developed pyelonephritis, functional impairment, or graft loss. There were no other urologic or renal complications observed in recipients of grafts with ureteral duplication. Conclusions: Donor kidneys with ureteral duplication may be used in renal transplant. The double LichGregoir technique may provide excellent results.

Modified Extravesical Ureteroneocystostomy in Cadaveric Kidney Transplantation with Completely Duplicated Ureters: A Case Report

“…Although ureteral duplication is the most common congenital malformation of the urinary tract, few cases in the literature describe kidney transplantations with completely duplicated ureters [1][2][3]5,7,9,10]. Here, we report a case study on cadaveric kidney transplantation from a completely duplicated ureter by modified extravesical ureteroneocystostomy where distal ureteric ends of duplicated ureters were spatulated and then their medial edges were approximated.…”

“…Completely duplicated ureters require several modifications to the extravesical ureteroneocystostomy. There are two primary approaches to re-implantation of duplicated ureters with the extravesical ureteroneocystostomy technique; both ureters can be separately anastomosed to the bladder [5], or a common ureteral ostium connected to the bladder can be formed between the distal parts of each ureter, known as ureteroureteral terminolateral anastomosis [6,7,9].…”

“…A kidney with duplicated ureters is more susceptible to post-operative urinary tract infections, stricture, reflux and urinary leakage; therefore, it is not a preferred option in kidney transplantations, in which postsurgical complications are the predominant cause of morbidity [3][4][5]. However, recent studies have revealed that the development of complications after transplantation of a donor kidney does not differ between completely duplicated ureters and a single ureter [5][6][7]. Given the increase in the number of hemodialysis patients over recent decades, and the shortage of renal allografts, development of a range of surgical techniques without postoperative complications is critical for the successful transplantation of a donor kidney with completely duplicated ureters [2,7,8].…”

“…However, recent studies have revealed that the development of complications after transplantation of a donor kidney does not differ between completely duplicated ureters and a single ureter [5][6][7]. Given the increase in the number of hemodialysis patients over recent decades, and the shortage of renal allografts, development of a range of surgical techniques without postoperative complications is critical for the successful transplantation of a donor kidney with completely duplicated ureters [2,7,8]. Here, we present a technique of modified extravesical ureteroneocystostomy in which a cadaveric kidney with complete ureteral duplication was successfully transplanted to a final-stage renal disease recipient.…”

Anatomical Variation and Its Management in Transplantation

“…Implantation: Both ureters may be implanted through separate incisions in the bladder, or they may be spatulated and joined along one edge before being implanted as a single ureter (36)(37)(38).…”