Secondary Pyeloureterostomy after Ureter Necrosis in Renal Transplant Recipients

Abstract

After kidney transplantation, urological complications account for significant morbidity necessitating reoperation in a substantial number of patients. In cases with urinary tract necrosis after renal transplantation secondary pyeloureterostomy represents an accepted method for urinary tract reconstruction. In our institution 2% of all kidney grafts required secondary pyeloureterostomy. In all cases the recipient’s own ureter was investigated before reoperation by retrograde pyeloureterography. Pyeloureterostomy was performed with a standard technic, the recipients own kidney being removed in all but 5 patients. All 25 patients had normal kidney function immediately after secondary pyeloureterostomy. Urological complications occurred in 7 patients (anastomotic leakages in 4, stenosis in 3); 5 out of 7 complications were managed conservatively (nephrostomy, transureteral stenting). Two patients needed reexploration for reanastomosis. Our results confirm the simple and safe technic of pyeloureterostomy for urinary reconstruction in patients with ureter necrosis after renal transplantation.

Native ureteropyelostomy: an effective therapy for urinary tract complications following kidney transplantation

“…Refashioning of the graft‐ureterocystostomy or suturing of smaller defects are therapeutic options. In case of failure of these limited surgical methods or in the presence of long ureteral strictures, ureteral leakage/ureteral necrosis, where total ureteric replacement is needed, ureteropyelostomy of the ipsilateral native ureter is an elegant surgical technique for reconstruction of the urinary tract . An advantage of the urinary tract reconstruction using the native ureter is the use of the physiologic anti‐reflux mechanism of the bladder.…”

Surgical Treatment for Ureteral Complications Following Renal Transplantations

“…In another study, the researchers obtained positive results by performing pyeloureterostomy after ureterovesical complications (18). Reconstruction of ureteral complications due to necrosis with pyeloureterostomy is known to be a simple and safe method (19).…”

Therapeutical options in ureteral necrosis following kidney transplantation

“…Two techniques are possible: transvesical (internal, Leadbetter‐Politano [12]) or external (Lich‐Gregoir adapted by Campos‐Freire [13]). In cases with long segmental stenosis or necrosis of the ureter again a native pyeloureterostomy may be helpful using ipsilateral recipients’ ureter if available [14, 15]. If not, a Boari flap or psoas hitch procedure can be done whenever the bladder is large enough.…”