title: Extended Ureteral Stricture Corrected With Appendiceal Replacement in a Kidney Transplant Recipient.
abstract: OBJECTIVE
  To present our technique of ureteral replacement with an appendicovesicostomy for the treatment of extended ureteral stricture after kidney transplantation. Ureteral stricture represents a urologic complication that may cause progressive function impairment and graft loss. Symptomatic ureteral stenosis is generally treated with a percutaneous nephrostomy and ureteral stenting. This approach may be initially effective, but often does not offer a long-term solution.
  
  
  METHODS
  A 48-year-old Caucasian man underwent kidney transplantation from a heart-beating deceased donor. The graft was transplanted to the right iliac fossa. Ureterovesical anastomosis was performed following the Lich-Gregoir technique. The postoperative period and follow-up were uneventful. Six months later the patient experienced an episode of acute pyelonephritis with hydronephrosis. A percutaneous nephrostomy was inserted, and an anterograde pyelography confirmed proximal dilatation with severe distal stenosis involving the entire ureter including the ureterovesical anastomosis. A 9 French Double-J stent was inserted antegradely and the patient was prepared for surgery.
  
  
  RESULTS
  We decided therefore to use the appendix as a conduit between the proximal transplant ureter and the bladder It was interposed with an isoperistaltic orientation and anastomosed to the ureter proximally and to the bladder distally (Lich-Gregoir reimplantation) using interrupted absorbable 5/0 sutures over a 10-Fr Double-J stent. The urethral catheter was removed on day 9 postoperatively and the patient was discharged with normal parameters. At 1 year follow-up the patient remains well.
  
  
  CONCLUSIONS
  The positive outcome confirms how the use of appendix as ureteral replacement is feasible and effective, allowing the salvage of the renal allograft.
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy. Electronic address: adanigl@hotmail.com.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Adani
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pravisani
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.affiliation: Department of Urology, Darent Valley Hospital, Dartford, Kent, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Bolgeri
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Lorenzin
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Terrosu
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
authors.forename: Rossano
authors.initials: R
authors.lastname: Girometti
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Cherchi
authors.affiliation: Kidney Transplant Program, Department of Medical and Biological Sciences, Academic Hospital, P.le S.M. della Misericordia, Udine, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001065:Appendix / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D066027:Transplant Recipients; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*