Abstract
Completely duplicated ureters are not commonly used in renal transplantation due to increased risk of postoperative complications, such as urinary tract infections, stricture, reflux and urinary leakage. Although recent results have indicated that the occurrence of these complications is similar to that of a single ureter, few reports exist of renal transplantations of kidneys with ureteral duplication. Here, we report successful renal transplantation of a cadaveric kidney with completely duplicated ureters to a 52-year-old final stage renal disease patient who had been on dialysis for 19 years. A modified extravesical ureteroneocystostomy technique was employed, in which distal ureteric ends were spatulated and their medial edges were approximated. Double-j stent catheters were inserted during the ureteroneocystostomy and removed after 21 days when progressive serum creatine levels had decreased. During 6 months following the operation so far, no urinary tract infections, hydronephrosis, pyelonephritis, stricture, or reflux was reported. We conclude that modified extravesical ureteroneocystostomy, a newly described technique is suitable for the transplantation of a cadaveric kidney with complete ureteral duplication.
Highlights
Ureteral duplication, where two ureters drain a single kidney, is the most common renal abnormality
A kidney with duplicated ureters is more susceptible to post-operative urinary tract infections, stricture, reflux and urinary leakage; it is not a preferred option in kidney transplantations, in which postsurgical complications are the predominant cause of morbidity [3,4,5]
Complete ureteral duplication in the donor has previously been a contraindication for renal transplantation, recent renal transplantation cases with completely duplicated ureters have been reported as successful with respect to post-operative graft function [5,9,10]
Summary
Ureteral duplication, where two ureters drain a single kidney, is the most common renal abnormality. A kidney with duplicated ureters is more susceptible to post-operative urinary tract infections, stricture, reflux and urinary leakage; it is not a preferred option in kidney transplantations, in which postsurgical complications are the predominant cause of morbidity [3,4,5]. Recent studies have revealed that the development of complications after transplantation of a donor kidney does not differ between completely duplicated ureters and a single ureter [5,6,7].
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