Bilateral renal autotransplantation with pyelovesicostomy: a surgical treatment of refractory enteric hyperoxaluria.
A 38-year-old man, with only 3 feet of small bowel remaining after multiple resections because of chronic inflammatory bowel disease, had severe symptomatic calcium oxalate nephroureterolithiasis. Because of the refractory symptoms, he was successfully treated with bilateral autotransplantation of the kidneys, totally bypassing the ureters. Anatomically effective urinary tract continuity was reestablished by means of bilateral pyelovesicostomies with concomitant rectus muscle vesicofixation to create direct stone-dumping channels into the urinary bladder. The patient is now completely without symptoms 18 months after surgery. A description and rationale for this surgical treatment is provided. Bilateral autotransplantation of the kidneys with direct drainage into the urinary bladder may be an attractive and viable therapeutic option in complicated patients with short-gut syndrome and severe refractory calcium oxalate nephroureterolithiasis.
Salvatierra
O
O
Department of Surgery, University of California, San Francisco 94143-0116.
Longaker
M
M
Crombleholme
T
T
D000009:Abdominal Muscles / Q000601:surgery; D000328:Adult; D000714:Anastomosis, Surgical; D003559:Cystostomy / Q000379:methods*; D006801:Humans; D006959:Hyperoxaluria / Q000601:surgery*; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D012008:Recurrence; D014514:Ureteral Calculi / Q000601:surgery*