Long-Term Outcome of Subcutaneous Pyelovesical Bypass in Extended Ureteral Stricture After Renal Transplantation

Abstract

Background and Purpose:

Extended ureteral stricture is a rare complication of renal transplantation. Its management remains challenging. The aim of our study was to report our 15 years of experience with subcutaneous pyelovesical bypass graft (SPBG) in selected renal transplant patients who presented with extended ureteral stricture and who were not eligible for open ureteral reconstruction.

Patients and Methods:

Seven patients were operated on between 1992 and 2007—six men and one woman—with a mean age at surgery of 47 years (range 30–67 y).

Results:

We report no encrustation or dislodgment with a mean follow-up of 6 years (range 1–14 y). Postoperative mortality was null. During the follow-up, three patients died: Two from an extrarenal cause with a functional SPBG and a stable renal function; one from septic shock after fungic colonization of the prosthesis. Asymptomatic urinary tract infection developed in two other patients, with no renal function impairment.

Conclusion:

Despite a 47% rate of infection (3/7), SPBG can be a safe and efficient alternative to open surgery to save many years of graft function in renal transplant patients who present with extended ureteral stricture.

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References

Whang

, Geffner

, Baimeedi

et al. Urologic complications in over 1000 kidney transplants performed at the Saint Barnabas healthcare system. Transplant Proc, 2003; 35:1375–1377.

Shoskes

, Hanbury

, Cranston

, Morris

. Urological complications in 1,000 consecutive renal transplant recipients. J Urol, 1995; 153:18–21.

Desgrandchamps

, Duboust

, Teillac

et al. Total ureteral replacement by subcutaneous pyelovesical bypass in ureteral necrosis after renal transplantation. Transpl Int, 1998; 11,suppl 1:S150–S151.

Desgrandchamps

, Paulhac

, Fornairon

et al. Artificial ureteral replacement for ureteral necrosis after renal transplantation: Report of 3 cases. J Urol, 1998; 159:1830–1832.

Desgrandchamps

, Cussenot

, Meria

et al. Subcutaneous urinary diversions for palliative treatment of pelvic malignancies. J Urol, 1995; 154:367–370.

Azhar

, Hassanain

, Aljiffry

et al. Successful salvage of kidney allografts threatened by ureteral stricture using pyelovesical bypass. Am J Tranplant, 2010; 10:1414–1419.

Ahmadzadeh

. Clinical experience with subcutaneous urinary diversion: New approach using a double pigtail stent. Br J Urol, 1991; 67:596–599.

Lingam

, Paterson

, Lingam

et al. Subcutaneous urinary diversion: An alternative to percutaneous nephrostomy. J Urol, 1994; 152:70–72.

Shokeir

, Shamaa

, Bakr

et al. Ileal ureter in renal transplant recipients. Transplant Proc, 1993; 25:2339–2340.

10.

Beckingham

, O'Rourke

, Rigg

, Bishop

. Pelvivesicostomy for ureteric stenosis or necrosis following renal transplantation. Br J Surg, 1994; 81:1373.

11.

Kennelly

, Konnak

, Herwig

. Vesicopyeloplasty in renal transplant patients: A 20-year followup. J Urol, 1993; 150:1118–1120.

12.

Aminsharifi

, Taddayun

, Jafari

, Ghanbarifard

. Pyelovesical bypass graft for palliative management of malignant ureteric obstruction: Optimizing the technique by percutaneous access to the bladder using a split Amplatz sheath. Urology, 2010; 76:993–995.

13.

Jabbour

, Desgrandchamps

, Angelescu

et al. Percutaneous implantation of subcutaneous prosthetic ureters: Long-term outcome. J Endourol, 2001; 15:611–614.

14.

Schmidbauer

, Kratzik

, Klingler

et al. Nephrovesical subcutaneous ureteric bypass: Long-term results in patients with advanced metastatic disease—improvement of renal function and quality of life. Eur Urol, 2006; 50:1073–1078.