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Han DS, Johnson JP, Schulster ML, Shah O. Indications for and results of renal autotransplantation. Curr Opin Nephrol Hypertens 2023; 32:183-92. [PMID: 36683544 DOI: 10.1097/MNH.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. RECENT FINDINGS Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists. SUMMARY In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
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Matsuda Y, Inoue T, Maeno A, Koizumi A, Yamamoto R, Nara T, Kanda S, Numakura K, Saito M, Narita S, Satoh S, Habuchi T. A patient with synchronous bilateral low-grade upper tract urothelial carcinoma who underwent nephroureterectomy and total ureterectomy with ileal ureteric replacement. Int Cancer Conf J 2020; 9:82-87. [PMID: 32257759 DOI: 10.1007/s13691-020-00402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/17/2020] [Indexed: 11/29/2022] Open
Abstract
We present the case of a synchronous bilateral low-grade upper-tract urothelial carcinoma patient who underwent left nephroureterectomy and right total ureterectomy with ileal ureteric replacement resulting in a favorable prognosis. A 66-year-old male presented with bilateral hydronephrosis. Computed tomography revealed left pelvic and right upper-middle ureteral tumors with no lymph node swelling or distant metastasis. The patient underwent a left nephroureterectomy with a bladder cuff, and histopathology revealed a low-grade urothelial carcinoma. Considering the contralateral low-grade nature as revealed in histopathology and the right retrograde ureterography being noninvasive, he underwent a right total ureterectomy with ileal ureteric replacement. Histopathology of the right ureter revealed a low-grade urothelial carcinoma. The patient successfully avoided an anephric status without renal function deterioration for 4 years with a transurethral resection for a recurrent small papillary bladder tumor on 18 months after the total ureterectomy.
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Affiliation(s)
- Yoshinori Matsuda
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan.,Department of Urology, Akita City Hospital, Akita, Japan
| | - Takamitsu Inoue
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Atsushi Maeno
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan.,Department of Urology, Akita City Hospital, Akita, Japan
| | - Atsushi Koizumi
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Ryohei Yamamoto
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Taketoshi Nara
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Sohei Kanda
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Kazuyuki Numakura
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Mitsuru Saito
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Shintaro Narita
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Shigeru Satoh
- 2Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Tomonori Habuchi
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
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Cheng SD, Li WQ, Mu L, Ding GP, Zhang B, Shen C, Ying ZW, Yang KL, Hao H, Li XS, Zhou LQ. [Application of totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis in upper urinary tract urothelial carcinomas treatment]. Beijing Da Xue Xue Bao Yi Xue Ban 2019; 51:758-763. [PMID: 31420636 DOI: 10.19723/j.issn.1671-167x.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis in the treatment of upper urinary tract urothelial carcinoma (UTUC), and to review the experience of renal autotransplantation for UTUC treatment. METHODS One case of applying the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis to the UTUC treatment was reported, and related literature was reviewed. The patient was a sixty-four-year old man who received right radical nephroureterectomy for right ureteral carcinoma 1 year before and diagnosed as left ureteral carcinoma(G2, high grade) this time. In order to preserve his renal function and avoid the shortness of common kidney-sparing surgery, a totally extraperitoneal procedure, including retroperitoneoscopic nephrectomy, ureterectomy, renal autotransplantation and Boari flap-pelvis anastomosis, was performed to the patient. RESULTS The operation was completed successfully without perioperative complications. The renal function recovered to preoperative level within 1 week. No deterioration of renal function during the follow-up and no tumor recurrence was observed under cystoscopy at the 3-month postoperative consult. CONCLUSION The totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis is a feasible and effective treatment for UTUC. The innovative procedure has several advantages compared to the former ones. The extraperitoneal procedure results in significantly less pain, shorter hospital stay, decreased overall time to recovery and lower bowel complications risk without warm ischemia time extension. Meanwhile, the Boari flap-pelvis anastomosis simplifies the follow -up protocols and creates an easy route for cystoscopy and topical therapy. From the systematic clinical analysis, as well as the related literature review, it's been concluded that the renal autotransplantation can be a reasonable option for the patients who have UTUC in solitary kidney or have bilateral UTUC. This type of treatment possesses advantages of preservation of renal function and total resection of malignant lesions. But long-term data and large cohort study on renal function or tumor recurrence are still absent which will be necessary to confirm the advantages of this approach.
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Affiliation(s)
- S D Cheng
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - W Q Li
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People's Hospital, Yichang 443003, Hubei, China
| | - L Mu
- Central Operating Room, Peking University First Hospital, Beijing 100034, China
| | - G P Ding
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - B Zhang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - C Shen
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - Z W Ying
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - K L Yang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - H Hao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - X S Li
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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Ou YC, Hu CY, Cheng HL, Yang WH. Long-term outcomes of total ureterectomy with ileal-ureteral substitution treatment for ureteral cancer: a single-center experience. BMC Urol 2018; 18:73. [PMID: 30170590 PMCID: PMC6119331 DOI: 10.1186/s12894-018-0389-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background To explore the feasibility and long-term outcomes of renal preservation in a retrospective cohort of patients with ureteral urothelial carcinoma undergoing total ureterectomy with ileal-ureteral substitution. Methods A retrospective review of the data from patients treated with total ureterectomy with ileal-ureteral substitution from 1988 to 2016 was performed. The pre-operative oncological status, long-term oncological outcome, long-term renal functional outcome, early and late complications were analyzed. Results A total of eight patients with a median age of 70 years were included. The median follow-up time was 109 months. Six patients had multi-focal tumor involvement over the target ureter, and six patients had bilateral upper tract involvement. Only one patient encountered the upper-tract recurrence. The 2 and 5-year cancer-specific survival rates were 87.5 and 75.0%, respectively. The renal function was well-preserved in most patients, with only one patient needed life-long postoperative hemodialysis. Five patients experienced early complications and four patients experienced late complications. No perioperative mortality happened. Conclusions A total ureterectomy with an ileal-ureteral substitution is feasible for treating ureteral urothelial carcinoma when a renal-sparing procedure is indicated. It provides good long-term oncological outcomes over the upper tract, and it also preserves the renal function.
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Affiliation(s)
- Yin-Chien Ou
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Che-Yuan Hu
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Hong-Lin Cheng
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Wen-Horng Yang
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China.
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Alameddine M, Moghadamyeghaneh Z, Yusufali A, Collazo AM, Jue JS, Zheng I, Morsi M, Prakash NS, Gonzalez J. Kidney Autotransplantation: Between the Past and the Future. Curr Urol Rep 2018; 19:7. [PMID: 29399714 DOI: 10.1007/s11934-018-0749-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords "autologous transplantation" and "kidney." RECENT FINDINGS Early outcomes of robotic KAT are encouraging and have been associated with fewer complications and shorter hospital stay, but require robotic technique proficiency. KAT is an important method to manage selected complex urological pathologies. Robotic KAT is promising. Nevertheless, future studies should utilize larger patient cohorts to better assess the risks and benefits of KAT and to further validate this approach.
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Affiliation(s)
- Mahmoud Alameddine
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA.
| | - Zhobin Moghadamyeghaneh
- Department of Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Ali Yusufali
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Alexa Marie Collazo
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Joshua S Jue
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Ian Zheng
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Mahmoud Morsi
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | | | - Javier Gonzalez
- Hospital Central de la Cruz Roja, Universidad Alfonso X El Sabio, Madrid, Spain
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Woods T, Jennings NB, Fernandez HT, Onaca N, Carlile BK, Levy MF, Gould DL, Ruiz R. Renal Autotransplantation in Lynch Syndrome: A Viable Option in a Patient With Contralateral Metachronous Ureteral Cancer. Am J Transplant 2015; 15:2507-10. [PMID: 25847116 DOI: 10.1111/ajt.13279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/18/2015] [Accepted: 02/22/2015] [Indexed: 01/25/2023]
Abstract
The success of human kidney allotransplantation was realized over six decades ago. First described 50 years ago, renal autotransplantation has been utilized sparingly as a salvage procedure for patients at risk of losing renal function, either from a benign or malignant condition. While classically associated with colorectal malignancies, Lynch syndrome also carries a small yet significant risk for the development of ureteral carcinoma. For these patients who develop chronic kidney disease, allotransplantation may not be an option due to the lifelong risk of several malignancies. We report the first known case of renal autotransplantation in a patient with metachronous ureteral cancer due to Lynch syndrome.
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Affiliation(s)
- T Woods
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - N B Jennings
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - H T Fernandez
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - N Onaca
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - B K Carlile
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - M F Levy
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - D L Gould
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
| | - R Ruiz
- Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center at Fort Worth, Fort Worth, TX
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Sood A, Jeong W, Ahlawat R, Abdollah F, Sammon JD, Bhandari M, Menon M. Minimally invasive renal autotransplantation. J Surg Oncol 2015; 112:717-22. [PMID: 25995142 DOI: 10.1002/jso.23939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022]
Abstract
Minimally invasive renal allotransplantation techniques have been recently described; reported benefits include reduced morbidity/complications. These benefits have been successfully adapted for minimally invasive renal autotransplantation, however, in a non-oncological setting. We, here, describe a novel alternative robot-assisted renal autotransplantation technique, utilizing GelPOINT, which by permitting ex vivo graft examination and surgery might allow further broadening of indications for minimally-invasive renal autotransplantation, to include complex oncological renal/ureteral lesions. Future studies are needed to evaluate the utility of these techniques.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mahendra Bhandari
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
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