Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre

Abstract

SummaryThis study was conducted to review the outcomes of patients who had undergone surgical repair of a ureteric stricture following renal transplantation. All patients who developed a ureteric stricture and underwent ureteric reconstruction following renal transplantation, between December 2003 and November 2013, were reviewed. One thousand five hundred and sixty renal transplants were performed during the study period. Forty patients required surgical repair of a ureteric stricture (2.5%, 25 male, median age 48 ). The median time to stricture was 3 [1-149] months. 19 patients were reconstructed by reimplantation to the bladder, 18 utilized a Boari flap, two were a pre-existing ileal conduit and one was an anastomosis to a native ureter. In one patient, reconstruction was impossible and consequently an extra-anatomic stent was used. Two patients required re-operation for restricture and kinking. Median serum creatinine at 12 months following surgery was 148 [84-508] lmol/l. There was no 90-day mortality. Eleven grafts were lost at the time of this study, a median time of 11 [1-103] months after reconstruction. The incidence of ureteric stricture following renal transplant is low. Surgical reconstruction of the transplant ureter is the optimal treatment and is successful in the majority of patients.

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

“…However, Pike and associates stated that this method was not appropriate as dissection of the native ureter is often difficult in the presence of a transplanted kidney and the integrity of a native ureter is mostly not known or investigated. 6 Here, however, we showed that assessment of the integrity of the ureters can be done properly by urologists using urethrocystoscopy during the preoperative period. Moreover, this method provides the opportunity to directly measure the length of the rest of the ureter and to place into the lumen of the ureter one of the stents to make it easer to find the ureter during the operation.…”

“…[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.…”

“…1,2 The 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.…”

“…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. 6 Case 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.…”

Use of a modifiedBoari flap for the treatment of a proximal ureteral obstruction in a cat

“…When techniques for reconstruction of the proximal ureter in humans are being considered, there are several guiding surgical principles including techniques that allow for a wide, tension free and water tight anastomoses; the preservation of blood supply; and complete excision of the underlying pathology to prevent stricture recurrence . Surgical techniques currently performed in man include ureteroureterostomy, transureteroureterostomy, downward nephropexy, ureterocalicostomy, Boari bladder flap, psoas hitch, bowel interposition, pyeloplasty, renal autotransplantation, and nephrectomy . The technique chosen often depends on the location of the obstruction as well as its length.…”