Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries.
OBJECTIVE
To evaluate the efficacy of laparoscopic nephrectomy with autotransplantation in cases of severe proximal ureteral damage. Many patients with complex proximal ureteral injuries have good functional renal parenchyma and wish to salvage their kidney. Autotransplantation is a viable alternative to nephrectomy in these frustrating situations.


METHODS
Two patients, aged 32 and 36 years, underwent laparoscopic nephrectomy and autotransplantation for treatment of severe proximal ureteral injuries. The injuries included a ureteropelvic junction avulsion and a proximal ureteral avulsion, respectively. Both patients had good functional renal parenchyma. A transperitoneal laparoscopic approach was used, and the kidney was removed by way of a Gibson incision.


RESULTS
The procedures were successful, with immediate return of renal function in both patients. A pyeloureterostomy to the native distal ipsilateral ureter was required in one and a direct ureterovesical anastomosis was performed in the other. In the 2 patients, the warm ischemia time was 4.5 and 4 minutes, the transplant operative time 175 and 150 minutes, and the estimated blood loss 150 and 75 mL, respectively. No intraoperative complications occurred. At follow-up, the kidneys were functional, and the patients had returned to their normal activity.


CONCLUSIONS
Laparoscopic nephrectomy with autotransplantation is an excellent alternative to nephrectomy or bowel interposition in patients with proximal ureteral loss, irrespective of the contralateral renal function. This procedure is associated with acceptable morbidity and preserves the renal function. This approach is desirable in those patients who have had complications from other surgical procedures and are otherwise facing the loss of a normally functioning kidney.
Shekarriz
B
B
Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94143-0738, USA.
Lu
H
H
Duh
Q
Q
Freise
C E
CE
Stoller
M L
ML
D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007669:Kidney Calculi / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D020127:Recovery of Function; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries* / Q000637:transplantation*; D014950:Wounds, Penetrating / Q000209:etiology / Q000601:surgery*