V02-04: Laparoscopic pyelo-ureterostomy of graft kidney to native ureter for a post tranplant recurrent ureteral stricture.
Complicated recurrent ureteral strictures post renal transplantation have traditionally been managed by standard open surgical technique. We describe a successfully performed laparoscopic pyelo-ureterostomy between the graft kidney and native ureter for a long segment recurrent distal ureteral stricture in a 40 year old female.
The patient had undergone a living related renal transplantation 3.5 years ago. She developed a distal ureteral stricture 3 years later and underwent an antegrade placement of a nephroureteral stent after balloon dilatation of the stricture. A month later she required an exploration, excision of distal ureteral strictured segment and ureteroneocystostomy for obstructive uropathy. Four months later she again presented with oliguria, rising creatinine and moderate hydroureteronephrosis. This time a laparoscopic pyelo-ureterostomy was performed using conventional three ports (two 10mm and one 5mm) triangulated towards the graft kidney. Intraoperative use of a 12MHz drop-in ultrasound probe aided in identification of the dilated graft pelvis and preoperative ureteral catheterisation helped in identification of right native ureter. Spatulated tension free anastomosis was performed with Polyglactin 4-0 sutures.
Operative time was 112 min with no intra operative complication. Postoperative course was uneventful. Hemoglobin drop was 0.2 gm/dL. Drain and catheter were removed on third postoperative day. Postoperative hospital stay was four days. Ultrasound on discharge showed resolution of the hydroureteronephrosis. DJ stent was removed after 15 days of surgery.
Laparoscopic pyelo-ureterostomy is a safe and efficacious technique for management of complicated recurrent ureteral strictures post renal transplantation. It additionally offers better comesis and shorter convalescence.