Ligation of the Native Ureter as an Alternative to Nephrectomy in Paediatric Renal Transplantation

Abstract

Purpose Native nephrectomy before or during transplantation has some indications in paediatric recipients, including intractable hypertension, polyuria, intractable massive proteinuria, recurrent renal infections and in very young patients. Another indication for nephrectomy is the need of native ureter for urinary tract reconstruction, although ureteroneocystostomy is the primary techniques. We describe our experience about intentional ligation of native ureter as an alternative to nephrectomy in paediatric renal transplant recipients. Material and Methods Between January and October 2009, 22 paediatric renal transplants were performed. In 8 (36 %) patients (age range, 8 to 18 years; mean age, 11,6 years), a native ipsilateral nephrectomy was planned for intractable hypertension (2 pts), polyuria (3 pts), intractable massive proteinuria (1 pt), recurrent renal infections (1 pt) and irreparable lesion of the graft ureter (1 pt). All 8 patients (planned for a native nephrectomy) underwent native ureteral ligation without native nephrectomy. Follow-up ranged 1 to 9 months (mean, 4,1 months) and consisted in periodic evaluation for flank pain, renal ultrasound and doppler, urinalysis and blood pressure. Results None patients with native ureteral ligation required secondary nephrectomy. Postoperative doppler scan at 72 hours showed a decrease of blood flow to the native kidney and at 1 week absence of renal blood supply. At 8-12 weeks the ultrasound showed a complete renal atrophy. None patients had pyelonephritis or pain during follow-up period. Hypertension was not noticed. Conclusions The intentional ligation of the native ureter without native nephrectomy in paediatric renal transplant recipients is safe, effective and it represents a mininvasive alternative to surgical nephrectomy. Native nephrectomy before or during transplantation has some indications in paediatric recipients, including intractable hypertension, polyuria, intractable massive proteinuria, recurrent renal infections and in very young patients. Another indication for nephrectomy is the need of native ureter for urinary tract reconstruction, although ureteroneocystostomy is the primary techniques. We describe our experience about intentional ligation of native ureter as an alternative to nephrectomy in paediatric renal transplant recipients. Between January and October 2009, 22 paediatric renal transplants were performed. In 8 (36 %) patients (age range, 8 to 18 years; mean age, 11,6 years), a native ipsilateral nephrectomy was planned for intractable hypertension (2 pts), polyuria (3 pts), intractable massive proteinuria (1 pt), recurrent renal infections (1 pt) and irreparable lesion of the graft ureter (1 pt). All 8 patients (planned for a native nephrectomy) underwent native ureteral ligation without native nephrectomy. Follow-up ranged 1 to 9 months (mean, 4,1 months) and consisted in periodic evaluation for flank pain, renal ultrasound and doppler, urinalysis and blood pressure. None patients with native ureteral ligation required secondary nephrectomy. Postoperative doppler scan at 72 hours showed a decrease of blood flow to the native kidney and at 1 week absence of renal blood supply. At 8-12 weeks the ultrasound showed a complete renal atrophy. None patients had pyelonephritis or pain during follow-up period. Hypertension was not noticed. The intentional ligation of the native ureter without native nephrectomy in paediatric renal transplant recipients is safe, effective and it represents a mininvasive alternative to surgical nephrectomy.