title: Urinary tract reconstruction using the controlateral native ureter and a combined open-retroperitoneoscopic approach after renal transplantation.
abstract: An alternative technique for urinary tract (UT) reconstruction is described in a renal transplant recipient who developed a severe stenosis of the graft ureter. This approach entails the retroperitoneoscopic preparation of the native ureter contralateral to the graft, followed by an open reconstruction of the UT. The ureter was dissected along its entire length to the level of the iliac vessels, with its associated mesentery still attached in order to preserve the vascular supply. The corresponding native kidney contralateral to the graft was endoscopically removed. A longitudinal sub-umbilical incision allowed the excision of the stenotic tract and the reconstruction of the UT by means of a manual end-to-end anastomosis between the new ureter and the graft pelvis. No post-operative complications occurred and renal function immediately resumed. The approach described represents an alternative solution for the surgical management of severe ureteric graft stenosis. We believe that the magnification of the anatomy granted by the endoscope during the dissection of the ureter and neighboring structures provides the gentle handling of the tissues and the remote dissection away from the ureter with the highest precision.
authors: Transplant and Renal Failure Unit, Department of Surgery, University of L'Aquila, L'Aquila, Italy. gorlando@wfubmc.edu
authors: Giuseppe
authors: G
authors: Orlando
authors: Luigi
authors: L
authors: Di Clemente
authors: Gianpiero
authors: G
authors: Gravante
authors: John
authors: J
authors: Overton
authors: Pierpaolo
authors: P
authors: Di Cocco
authors: Vinicio
authors: V
authors: Rizza
authors: Maurizio
authors: M
authors: D'Angelo
authors: Antonio
authors: A
authors: Famulari
authors: Francesco
authors: F
authors: Pisani
mesh_terms: D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D012187:Retroperitoneal Space; D014513:Ureter / Q000601:surgery*; D014551:Urinary Tract / Q000601:surgery*