J Korean Surg Soc.  2002 Jul;63(1):79-83.

Native Ureterotransplant Ureterostomy for Ureteral Obstruction after Simultaneous Pancreas Kidney Transplantation

• Lee S
• Lee JC
• Seol JW
• Kim JS
• Park CH
• Kim SI
• Joo SH
• Lee YC
• Park SG
• Yang DY
• Kim SY
• Kim HC
• Bae SH
• Hyun SJ
• Park CJ
• Yoon DW

Abstract

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.

Keyword

Native ureterotransplant ureterostomy; Pancreas kidney transplantation

MeSH Terms

Adult
Constriction, Pathologic
Creatinine
Cystoscopes
Diabetes Mellitus
Diabetic Nephropathies
Drainage
Follow-Up Studies
Humans
Insulin
Kidney Transplantation*
Kidney*
Male
Pancreas*
Stents
Tissue Donors
Ultrasonography
Ureter*
Ureteral Obstruction*
Ureterostomy*
Urinary Bladder
Creatinine
Insulin