Clin Transplant Res.  2024 Mar;38(1):57-62. 10.4285/kjt.23.0054.

Inferior polar nephrectomy and vesicocalicostomy for complete ureteric stricture following antibody-mediated rejection in ABO-incompatible living donor kidney transplant: a report of a rare case

• Kumar BN
• Shukla AK
• Datt B
• Prakash S

• KMID: 2555998
• DOI: http://doi.org/10.4285/kjt.23.0054

Abstract

Renal transplant recipients are prone to urological complications, the most common of which is stricture of the transplant ureter. We present a rare case of complete ureteric stricture in a 37-year-old man who had undergone spousal living donor kidney transplantation with ABO incompatibility. Initially, treatment involved creating an anastomosis between the native right ureter and the renal pelvis of the transplanted kidney. However, the stricture recurred. Subsequently, the patient was successfully treated with inferior polar nephrectomy and vesicocalicostomy, which entailed anastomosing the lower calyx of the transplanted kidney to the bladder. After 7 months of follow-up, the patient continued to exhibit stable renal function without stricture recurrence.

Keyword

Kidney transplantation; Graft rejection; Ureteral obstruction; Urologic surgical procedures; Surgical anastomosis

Figure

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  Fig. 1 Preoperative computed tomography renal angiography of the donor, revealing bilateral single renal arteries and veins. The blood supply to the inferior pole of the left kidney is clearly visible.

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  Fig. 2 Ultrasonography indicating hydronephrosis of the transplant kidney.

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  Fig. 3 Images captured during pyeloureterostomy. The yellow arrow indicates the anterior abdominal wall muscle that is adherent to the transplanted kidney. The black arrow marks the double J (DJ) stent visible within the rejected, fibrosed transplant ureter. The blue arrow highlights the anastomosis of the native right ureter with the intrarenal pelvis of the transplanted kidney, performed over a DJ stent.

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  Fig. 4 (A) Inferior polar nephrectomy and vesicocalicostomy surgery. An accidental tear in the transplant kidney parenchyma occurred during the initial dissection due to extensive perinephric adhesions (indicated by the suction cannula). (B) The tip of the inferior calyx was identified using a percutaneous nephrostomy needle, which was positioned on the renal parenchyma (indicated by the arrow) under fluoroscopic guidance during nephrostogram, prior to inferior polar nephrectomy.

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  Fig. 5 (A) Inferior polar nephrectomy. (B) The inferior calyx and bladder, prepared for anastomosis. (C) Image captured during vesicocalicostomy; the double J stent and percutaneous nephrostomy are visible. (D) Completed vesicocalicostomy with omentum positioned for wrapping.

Reference

1. Krajewski W, Dembowski J, Kołodziej A, Małkiewicz B, Tupikowski K, Matuszewski M, et al. 2016; Urological complications after renal transplantation: a single centre experience. Cent European J Urol. 69:306–11.

2. Zavos G, Pappas P, Karatzas T, Karidis NP, Bokos J, Stravodimos K, et al. 2008; Urological complications: analysis and management of 1525 consecutive renal transplantations. Transplant Proc. 40:1386–90. DOI: 10.1016/j.transproceed.2008.03.103. PMID: 18589113.

3. Lempinen M, Stenman J, Kyllönen L, Salmela K. 2015; Surgical complications following 1670 consecutive adult renal transplantations: a single center study. Scand J Surg. 104:254–9. DOI: 10.1177/1457496914565419. PMID: 25567856.

4. Shahait M, Jackman SV, Averch TD. Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, Wein AJ, editors. Urological complications of renal transplantation. Campbell Walsh Wein urology. 12th ed. Elsevier;2020. p. 1936–41.

5. Kroczak T, Koulack J, McGregor T. 2015; Management of complicated ureteric strictures after renal transplantation: case series of pyelovesicostomy with Boari flap. Transplant Proc. 47:1850–3. DOI: 10.1016/j.transproceed.2015.02.020. PMID: 26293062.

6. Ehrlich RM, Whitmore K, Fine RN. 1983; Calycovesicostomy for total ureteral obstruction after renal transplantation. J Urol. 129:818–9. DOI: 10.1016/S0022-5347(17)52380-0. PMID: 6341626.

7. van Son WJ, Hooykaas JA, Slooff MJ, Tegzess AM. 1986; Vesicocalicostomy as ultimate solution for recurrent urological complications after cadaveric renal transplantation in a patient with poor bladder function. J Urol. 136:889–91. DOI: 10.1016/S0022-5347(17)45117-2. PMID: 3531554.

8. Higgins MM, Walker JP, Daily MF, Gupta S. 2017; Open Vesicocalicostomy for the management of transplant ureteral stricture. Urol Case Rep. 13:74–6. DOI: 10.1016/j.eucr.2017.03.028. PMID: 28507909. PMCID: PMC5429138.

9. Astolfi RH, Patavino GA, Rosso CF, Silva Junior HT, Pestana JO, Meller AE, et al. 2018; Ureterocalicostomy with lower pole nephrectomy in a renal transplant: a case report. Am J Transplant. 18:2347–51. DOI: 10.1111/ajt.14938. PMID: 29767455.