Intraoperative vascular localization to facilitate endopyelotomy after renal transplantation.
BACKGROUND
Pelviureteric junction (PUJ) obstruction after renal transplantation is uncommon. Surgical correction can be technically challenging due to dense perinephric adhesions and variable hilar vascular anatomy. Endopyelotomy is well established in the treatment of PUJ obstruction in native kidneys.


METHODS
The present paper reports the first experience of antegrade visual cold-knife endopyelotmy performed in a renal allograft. In orientating the incision at the PUJ, preoperative imaging was supplemented by intrarenal Doppler ultrasound, using a probe designed for transoesophageal cardiac monitoring. To the authors' knowledge this approach has not previously been reported.


RESULTS
Renal vascular relationships were readily indentified by identifying arterial and venous waveforms.


CONCLUSIONS
For this uncommon procedure the use of intrarenal Doppler ultrasound provides greater security in avoiding inadvertent vascular injury.
Siddins
M
M
Department of Renal Transplantation, Queen Elizabeth Hospital, Woodville, South Australia, Australia. siddinsmark@hotmail.com
Kanchanabat
B
B
Rao
M M
MM
D003080:Cold Temperature; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging; D010388:Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D012077:Renal Artery / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014551:Urinary Tract / Q000000981:diagnostic imaging / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*