Kidney Autotransplantation in Complete Iatrogenic Injury of Ureter

Abstract

Introduction: Ureteral injuries represent less than 1% of all genitourinary traumas. In 75% of cases such complications are iatrogenic in nature and are induced by a medical procedures or physical intervention on tissues. Only 18% of the total can be attributed to urologic treatment, mainly to endoscopic procedures. There are many corrective measures to counteract urethral injuries however the mode or type of an intervention is dependent on a damage location and the length of urethral loss. As for the total ureter damage, it is recommended to replace the ureter by ileal interposition or to perform kidney autotransplantation. Materials and methods: 32 year old man was hospitalized due to URS induced ureteral avulsion located at lower kidney pole. In his case URS had been conducted to treat stone of left ureter. In view of the mentioned complications he qualified for kidney autotransplantation. After performed nephrectomy prepared kidney was repositioned to a right iliac fossa and renal artery and vein were anastomosed with iliac external vessels end-to-side. Subsequently ureter was anastomosed with urinary bladder by Lich -Gregoira technique. The patient left hospital 10 days after the procedure had been carried out. Control tests conducted 3 weeks after the autotransplantation showed correct vessels anastomosis as well as right renal secretion function Summary: Kidney autotransplantation is definitely the optimal form of treatment applied to ureteral injuries as it allows to maintain physiological urine outflow and to preserve other organ functions. As opposed to ileal interposition in this scenario we can avoid abnormal mucous secretion, electrolyte absorption, bacteriuria and vesicoileal reflux. Despite of kidney autotransplantation being a complicated procedure taking into account the requirement of extensive expertise in vascular surgery, it provides unrivaled choice to young men who would find kidney loss extremely hard to accept. In addition, from medical point of view kidney autotransplantation constitutes a rare but fascinating example where urology and transplantology as two distinctive fields of medicine come together to preserve patients quality of life.