title: Comparison of Native Ureteral Ligation and Open Nephrectomy for Pediatric Renal Transplantation.
abstract: OBJECTIVE
  In pediatric renal transplant recipients there are some indications for native nephrectomy, which can be performed before, during or after transplantation. Indications include massive proteinuria resistant to therapy, intractable hypertension, polyuria and chronic or recurrent kidney infections. Several scientific studies of adults have demonstrated a minimally invasive alternative to native nephrectomy, which consists of ligation of the native ureter without removing the kidney. We evaluated the safety and efficacy of this minimally invasive technique in pediatric recipients of renal transplantation.
  
  
  METHODS
  A total of 29 pediatric kidney transplant recipients underwent unilateral native ureteral ligation during renal transplantation between 2009 and 2013 (group A). In addition, a control group of 21 pediatric renal transplant recipients was enrolled who had undergone unilateral native nephrectomy between January 2005 and December 2008 (group B). Both groups were evaluated preoperatively by Doppler ultrasound of the native kidneys.
  
  
  RESULTS
  Statistical analysis of the 2 groups for the 3 main variables considered (surgical time, intraoperative blood loss and length of surgical scar) revealed a significant difference (Mann-Whitney U test, p <0.001). This finding confirmed the hypothesis that during renal transplantation ligation of the native ureter is less invasive than native nephrectomy.
  
  
  CONCLUSIONS
  Ligation of the native ureter without removal of the ipsilateral kidney is a feasible procedure in pediatric renal transplant recipients. This method is easy to perform and significantly less invasive than surgical nephrectomy.
authors.affiliation: Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Obstetric-Gynecological Sciences and Urological Sciences, University of Rome Sapienza (MI), Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Torino
authors.affiliation: Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Obstetric-Gynecological Sciences and Urological Sciences, University of Rome Sapienza (MI), Rome, Italy. Electronic address: innocenzi.michele@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Innocenzi
authors.affiliation: Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Obstetric-Gynecological Sciences and Urological Sciences, University of Rome Sapienza (MI), Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mele
authors.affiliation: Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Obstetric-Gynecological Sciences and Urological Sciences, University of Rome Sapienza (MI), Rome, Italy.
authors.forename: S Gerocarni
authors.initials: SG
authors.lastname: Nappo
authors.affiliation: Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Obstetric-Gynecological Sciences and Urological Sciences, University of Rome Sapienza (MI), Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Capozza
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008026:Ligation; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D014019:Tissue Donors; D066027:Transplant Recipients; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*
keywords: kidney transplantation; ligation; minimally invasive surgical procedures; nephrectomy; ureter