Korean J Transplant.  2022 Nov;36(Supple 1):S175. 10.4285/ATW2022.F-3012.

Reconstructive plastic surgery on the middle a third of the ureter of the transplanted kidney

• Tureyev U

• KMID: 2535691
• DOI: http://doi.org/10.4285/ATW2022.F-3012

Abstract

Background
In obstructive uropathy, if the method of drainage of the kidney followed by antegrade/retrograde augmentation and stenting of the ureter of the transplant is ineffective, reconstructive plastic surgery on the urinary tract of the transplanted kidney is used by the open method.
Methods
Patient A, 46 years old, with a diagnosis of "stage 5 chronic kidney disease" in the outcome of autosomal dominant polycystic kidney disease after bilateral nephrectomy, kidney transplantation with ureteral graft stenting was performed. In the postoperative period, delayed graft function, oliguria was noted, the level of nitrogenous plasma slags decreased extremely slowly, nephrosclerosis (50%), acute tubular necrosis was diagnosed. Ten hemodialysis sessions were performed. The ureteral stent of the kidney transplant was removed on day 21. On day 39, the restoration of the graft function was noted. Two months after kidney transplantation, urolithiasis of the transplanted kidney, a stone of the upper third of the ureter of the transplant, necrosis of the ureter of the transplant, urinary congestion were diagnosed.
Results
Reconstructive plastic surgery was performed on the ureter of the transplanted kidney, removal of the concretion of the upper third of the ureter of the graft, resection of the ureter of the graft, formation of ureteroureteroanastomosis with stenting of the ureter of the graft, percutaneous puncture nephrostomy of the renal graft in order to drain the cup-pelvic system and urine drainage. The postoperative period proceeded without complications.
Conclusions
The formation of ureteroureteroanastomosis in the upper third of the ureter of the graft with stenting and unloading of the cup-pelvic system by nephrostomic drainage are possible with perforative damage to the ureter due to prolonged concretion due to the lack of the possibility of using the ureter of their own kidneys.