New preperitoneal surgical approach to treat vesicoureteral stenosis or reflux after kidney transplantation
(2016) 23rd Annual meeting of the Belgian Transplant Society (BTS) — Location: Brussels, Belgium (4.March.2016)
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- Abstract
- The management of vesicoureteral anastomotic stenosis or reflux after kidney transplantation still remains challenging. If endourologic approach is not eligible, the surgical gold standard in many transplant centres is a pyeloureterostomy or ureteroureterostomy with the native ureter. We report an original preperitoneal approach to vesicoureteral reanastomosis in kidney transplant recipients not eligible for endourologic treatment. Between March 2011 and November 2015, 18 kidney transplant recipients benefited from this new surgical approach. Out of them, 14 have reached at least one year of follow-up and were included in the analysis. The indications were vesicoureteral reflux, anastomotic stenosis and leakage in 7, 5 and 2 patients, respectively. Briefly, a JJ stent was preoperatively inserted into the grafted ureter. The surgical approach was performed by a Pfannenstiel incision. The extraperitoneal space surrounding the bladder was dissected and the distal part of the grafted ureter was easily identified and cautiously mobilized. The anastomotic area was resected and a new vesicoureteral anastomosis was created, keeping the JJ stent in place for three weeks [Figure]. This surgical reintervention was performed 183 days (range, 17-2608) after kidney transplantation. The median surgical time was 180 minutes (range, 112-314). Postoperative course was uncomplicated in all the patients. During a median follow-up of 996 days (range, 332-1629), two patients developed symptomatic recurrence of vesicoureteral reflux needed a classic ureteroureterostomy respectively 1 year and 3 months after the first surgical reintervention. This new surgical approach has the following advantages : 1) easy technique with low morbidity, 2) avoids transperitoneal dissection, 3) potential of a more esthetic access, and 4) avoids native nephrectomy.
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Darius, T., Buemi, A., Coubeau, L., De Pauw, L., De Meyer, M., & Mourad, M. (2016). New preperitoneal surgical approach to treat vesicoureteral stenosis or reflux after kidney transplantation. 23rd Annual meeting of the Belgian Transplant Society (BTS), Brussels, Belgium. https://hdl.handle.net/2078.5/31082