Renal Autotransplantation for Iatrogenic High-Grade Ureteric Stricture

Abstract

A 47-year-old Hispanic woman developed a chronically obstructed left kidney, due to a long-segment ureteric stricture deemed not amenable to reimplantation, following left ovarian cyst excision in 2004. Therefore, a ureteral stent requiring exchange every 3 months was necessary, due to hydronephrosis, recurrent urosepsis, chronic pain, and a poor quality of life. Her medical history was complicated by hypertension, poorly controlled diabetes mellitus, and microalbuminuria, suggesting early diabetic nephropathy. A left nephrectomy was recommended. This was deferred, due to concern for progressive kidney failure associated with her comorbidities. A radionuclide Tc-99m MAG3 renal scan revealed differential perfusion as follows: 44% left kidney and 56% right kidney, with symmetrical uptake on the renogram phase and delayed excretion on the left, which were correctted following furosemide administration. A left ureteronephrectomy with autotransplantation of the left kidney and ureteroneocystostomy was performed in 2009. Since then, the patient has experienced no further complications or need for invasive procedures, with excellent diabetic control and stable renal function (eGFR > 60 mL/min/1.73 m2). This technique is seldom employed in the surgical management of complex ureteral injuries, but may be an alternative for appropriate cases.

Ureteral avulsion after ureteroscopy treated with renal auto-transplantation

“…Potential benefits of auto-transplantation include a relatively bloodless surgical field and hypothermic protection of the kidney against ischemia. 5 Meng and associates reported a case series of 7 patients with severe ureteral injuries not amenable to routine reconstruction with preoperative evaluation demonstrating comparable split renal function. Transperitoneal laparoscopic nephrectomy and auto-transplantation to the ipsilateral pelvis were performed.…”

Selective Detection of Nano-Sized Diagnostic Markers Using Au-ZnO Nanorod-Based Surface-Enhanced Raman Spectroscopy (SERS) in Ureteral Obstruction Models

“…Ureteral obstruction due to urinary stones, 1 , 2 congenital anomalies, 3 , 4 ureteral strictures, 5 , 6 and spinal cord injury 7 , 8 physically blocks the movement of urine from the kidney to the bladder, leading to renal injury. Obstructive uropathy can occur both unilaterally or bilaterally causing chronic or acute kidney disease.…”