Ligation of the native ureter in renal transplantation.
OBJECTIVE
Native ureteral ligation may be required in renal transplantation when ureteroureterostomy is performed. Native nephrectomy has been done to avoid the complication of hydronephrosis after native ureteral ligation. We reviewed the records of renal transplant recipients who underwent native ureteral ligation to determine the incidence of post-ligation symptoms and need for native nephrectomy.


METHODS
We retrospectively reviewed 1,275 renal transplants performed from January 1986 through September 1999, including 278 cases (22%) of native ureteral ligation. The majority of patients had anuria or oligouria before transplantation, although 3 were not dialysis dependent. Followup was 1 to 140 months. Charts were reviewed for flank pain, infection and the need for native nephrectomy.


RESULTS
Six of 278 patients (2.2%) required native nephrectomy 7 to 82 months after transplantation with flank pain as the indication in all. The cause of renal failure was polycystic disease in 3 of the 6 cases, unknown in 2 and diabetes in 1. The patient with diabetes had papillary necrosis and bleeding in the nephrectomized kidney. None of the 278 patients had infection and early post-ligation flank pain developed in only 1 (0.4%).


CONCLUSIONS
The native ureter may be safely ligated during renal transplantation. Late nephrectomy may be required in a small percent of cases, most commonly in those of polycystic disease. The need for nephrectomy is most often related to the original renal disease.
Gallentine
Michael L
ML
Department of Urology, Wilford Hall Medical Center, Methodist Specialty and Transplant Hospital, San Antonio, TX, USA.
Wright
Francis H
FH
D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*