Category: Reconstruction: Benign

MP14-4 - The management of post-transplant ureteric stenosis with transperitoneal transplant Pyelo-Native Ureterostomy (TTPNU)

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Ureteric complications post kidney transplantation are relatively common and may compromise the function of the transplanted kidney due to obstruction, infection and the need for recurrent intervention. Where endourological management of strictures fails, surgical revision is required. The mobilisation of the kidney, bladder and ureter is usually compromised by post-surgical scarring and a pragmatic technical approach to surgical correction is by using a transperitoneal approach to the transplanted kidney and utilising the mobilised ipsilateral ureter as a transplant pelvis to native ureterostomy.

Methods :

We searched our electronic database for ureteric re-implantation, and all case records were carefully reviewed to include only TTPNU. A control cohort of transplants without ureteric complications was also analysed.

Results :

Over an eight-year period from 2009 to 2017, 1455 kidney transplants were performed, and 37 (2.6%) patients required surgical revision of a ureteric complication. Ten patients were excluded as they did not fit the selection criteria.  TTPNU for transplant ureteric stenosis (TUS) was attempted in twenty-seven patients (n=27). Procedural success was 94% with good preservation of renal function and no graft losses.

Conclusions :

Where endo urologic solutions have failed, TTPNU appears a safe and effective surgical solution for transplant ureteric stenosis. The transperitoneal approach avoids technical issues with the mobilisation of the transplant kidney and mobilisation of the native ureter facilitates a tension-free anastomosis. 

Motaz ELMAHDY. Hassan

Specialist Registrar in Urology
Aberdeen Royal Infirmary
Aberdeen, Scotland, United Kingdom

Anita Chithiramohan

House Officer
Queen Elizabeth Hospital Birmingham
Birmingham, England, United Kingdom

Dr Chithiramohan is a UCL-graduate junior doctor working at Queen Elizabeth Hospital in Birmingham. Following her Integrated BSc in Primary Care, she has presented her research in psychiatry, general practice and urology both nationally and internationally, as both oral and poster presentations, and has won prizes for her publications. She enjoys clinical medicine and pursues her passion to teach medical students.

Mohammed Belal

Consultant Urological Surgeon
Queen Elizabeth Hospital Birmingham
Birmingham, England, United Kingdom

Nicholas Inston

Consultant Renal Surgeon
Queen Elizabeth Hospital Birmingham
Birmingham, England, United Kingdom