title: Salvage of difficult transplant urinary fistulae by ileal substitution of the ureter.
abstract: We report our experience with 4 cases of ileal substitution of the ureter after live-donor kidney transplantation and review the literature. The indications were recurrent ureteric fistula and obstruction in 3 cases and extensive necrosis of the ureter and renal pelvis in one case. Nephrostomy tube drainage was a useful adjunct to diagnosis and treatment of the 4 cases. No mortalities or graft losses were encountered and satisfactory graft function was maintained 2-14 years after ileal substitution of the ureter. Moreover, no electrolyte or acid-base disturbances were observed. One patient developed recurrent vesical stones 2 and 4 years after ileoureteral replacement secondary to bladder neck obstruction. Ileal substitution of the ureter seems a feasible operation to salvage difficult and recurrent transplant urinary fistulae in exceptional situations when it is impossible to restore urinary continuity using urinary tract tissues.
authors.affiliation: Urology & Nephrology Center, Mansoura, Egypt.
authors.forename: A A
authors.initials: AA
authors.lastname: Shokeir
authors.forename: M A
authors.initials: MA
authors.lastname: Shamaa
authors.forename: M A
authors.initials: MA
authors.lastname: Bakr
authors.forename: T A
authors.initials: TA
authors.lastname: el-Diasty
authors.forename: M A
authors.initials: MA
authors.lastname: Ghoneim
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D014515:Ureteral Diseases / Q000209:etiology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*