V6-08: Robotic Ureteral Reconstruction for Ureteral Complications of Kidney Transplants
Urologic complications after kidney transplantation are a significant cause of morbidity leading to decreased graft function or graft loss. Ureteral stricture is the most common complication with a reported incidence ranging between 0.6% to 10.6%. The reported incidence of vesicoureteral reflux (VUR) causing graft pyelonephritis is 0.1% to 3.5%._x000D_ _x000D_ Uretero-pyelostomy and uretero-ureterostomy utilizing the native ureter are well established surgical methods of transplant ureteral reconstruction._x000D_ _x000D_ The aim of this study is to evaluate the technique, feasibility and results of robotic-assisted laparoscopic reconstruction of the transplanted ureter with the native ipsilateral ureter._x000D_
We retrospectively reviewed six patients (3 male, 3 female) who underwent 5 robotic-assisted uretero-pyelostomies and 1 uretero-ureterostomy between 2013 and 2016. Mean follow-up time was 18 months (range 2 to 37 month)._x000D_ _x000D_ Four patients had significant ureteral obstructions and 2 had recurrent pyelonephritis due to VUR. 2 patients with obstruction had nephrostomy tubes (NT) at time of surgery and 2 had double J stents._x000D_ _x000D_ All patients were evaluated preoperatively with a voiding cysto-urethrogram (VCUG), cystoscopy and retrograde pyelography and MAG3 renal scan. 4 patients had a preoperative nephrostogram. Baseline post-transplant serum creatinine, pre-reconstruction serum creatinine, post-reconstruction serum creatinine were evaluated. A MAG3 renal scan was obtained post-operatively in case of increased creatinine._x000D_ _x000D_ All patients had postoperative cystograms and were followed with serum creatinine-GFR._x000D_
Each transplant ureteral reconstruction were completed successfully. There was one conversion to an open uretero-pyelostomy. Mean hospital stay was 3 days (range 2-4 days). One patient had a ureteral obstruction due to kinking of the JJ stent requiring a NT placement. _x000D_ After ureteral reconstruction. serum creatinine returned to baseline for all patients. No recurrent strictures were demonstrated by increasing serum creatinine or MAG3 renal scans. No recurrent episodes of pyelonephritis were found. There was no graft loss. _x000D_
Robotic-assisted reconstruction of the transplant ureter by uretero-pyelostomy or uretero-ureterostomy using the native ureter is feasible and can be safely performed with graft survival and low complication rates.