Successful transplantation of pediatric en bloc kidneys with bilateral double ureters

An Inguinal Approach to Complex Extravesical Ureteral Reimplantation

OBJECTIVE

To report our experience in applying the Lich-Gregoir extravesical ureteral reimplantation (EVR) approach to complex cases (megaureter, duplex systems) through a small inguinal incision, with the goal of minimizing invasiveness.

MATERIALS AND METHODS

We reviewed the records of all patients who underwent common sheath or tapered EVR through an inguinal incision. Patient characteristics and reflux grade were obtained, and outcomes were assessed. The technique involved a 2-cm incision made in the lowest inguinal skin crease, standard cord exposure and lateral retraction, and opening the floor of the canal to isolate the ureter. Excisional tapering was performed with the ureter dismembered from the bladder and then reimplanted via detrusorrhaphy, whereas common sheath reimplantation was performed with advancement fixation sutures and the ureters in situ.

RESULTS

Twenty-eight patients (15 males and 13 females) with a median age of 1.7 years (range: 0.9-4.8 years) were included. Fifteen patients had ureteral tapering, 12 underwent common sheath reimplantation, and 1 child had both. Success was seen in 94% for tapering and 92% for common sheath reimplants, with a mean follow-up of 29.6 months. There were no postoperative obstructions, urinary leaks, or wound infections.

CONCLUSION

The inguinal approach can safely and effectively be applied to cases of extravesical ureteral tapering and common sheath reimplantation.

Modified Extravesical Ureteroneocystostomy for Completely Duplicated Ureters in Renal Transplantation

INTRODUCTION

Completely duplicated ureters are the most common congenital malformation of the upper urinary tract. However, there are very few reports on transplantation using kidneys with double ureters, and the technique of ureterocystoneostomy for completely duplicated ureters has not yet been established.

PATIENTS AND METHODS

We treated 3 patients with completely duplicated ureters at our institutions from January 1998 to October 2005. We modified the extravesical technique for treating these 3 cases and evaluated the 52-month follow-up period for possible urological complications.

RESULTS

Neither urological complications nor urinary tract infections occurred in the follow-up period after using our new technique.

CONCLUSION

We conclude that this technique is an appropriate procedure for the transplantation of kidneys with completely duplicated ureters.

Experiences in Kidney Transplantation With Duplicated Ureters

INTRODUCTION

The purpose of this study was to evaluate the complications of duplicated ureters in renal transplant recipients.

METHODS

Between 1983 and 2004, 12 patients (median age 34 years) received renal transplants from donors with duplicated ureters. In four patients the ureter to bladder anastomoses were performed separately according to the method described by MacKinnon, including two cases transplanted with ureteral catheters because of narrow widths. In the following cases of eight duplicated ureters an anastomosis was performed between the distal part of each ureter to form a common ureteral ostium, which was connected to the urinary bladder. A ureteral catheter was used to the splint ureterovesical anastomosis.

RESULTS

No graft loss to ureteral complications was observed. There was no ureteral necrosis in the postoperative period. No clinical symptoms of ureteral junction obstruction were revealed after removing the ureteral catheter. By ultrasound examination four patients showed a slight temporary pyelocaliectasis was observed and four patients developed temporary urinary fistulas.

CONCLUSION

Our ureterocystoneostomy procedures with duplicated ureters were safe and useful in kidney transplantation.