Native ureteropyelostomy in the treatment of obstructive uropathy in adult renal transplant. Experience and technical alternatives

© 2013 AEU. Published by Elsevier Espaa, S.L.U. All rights reserved. Objective: To analyze and evaluate our experience in surgical treatment with the open approach of the complex ureteral stenosis after adult kidney transplantation in a tertiary level hospital in the last seven years. We have reviewed the different surgical options used.Patients and methods: A total of 589 consecutive adult renal transplants were performed fromJanuary 2005 to December 2012. Of these, 1.1% showed some degree of symptomatic obstructiveuropathy which after initial urinary diversion required open surgical approach using the ipsila-teral or contralateral native urinary tract. Characteristics of the patient, clinical examinationsperformed and surgical technique performed as well as their results are presented.Results: During the period under review, in 5 men and 2 women who had ureteral stenoses afterrenal transplant, 7 reparative surgeries were performed by open ureteropyelostomy, using ipsi-lateral native ureter in 6 cases and contralateral ureter in the remaining case. In one case,uretero-calicial anastomosis was performed due to severe pyelic shrinkage. There were no sig-nificant complications. Native kidney nephrectomy was not required for further complications.All the patients operated on had optimum plasma creatinine levels with resolution of previousdilatation.Conclusions: The initial percutaneous nephrostomy followed by open surgical repair usingnative ureter represents a definitive, valid and optimal alternative in terms of safety andpreservation of renal function.