Surgical Correction of Pyelo-Ureteral Junction Desease on Graft before Kidney Transplantation

Abstract

Before kidney transplantation, even without ultrasound alterations of donor urinary tract, we usually and carefully study kidney to be transplanted. We fill urinary tract retrogradly with physiological solution from distal ureter. With this method we can recognise stenosis, ectasis and, during a spontaneous emptying, an altered urinary flow due to a “pyelo-ureteral junction attitude”. After kidney transplantation, in fact, hyperdiuresis can unmask a pyelo-ureteral junction attitude with heavy functional rebounds. When, during graft's preparation, we recognize an altered flow, we operate it “on the bank” in order to a easier surgery than on a transplanted kidney, because of its site in iliac fossa, vascular anastomosis and fibrosis that will establish early. We don't use traditional pyeloplastic technique (Anderson Hynes). We use easier pyeloplastic techniques Y-V sec. Foley. Than we apply a ureteral catheter JJ Ch 6 to protect suture and finally we vitrify the suture with fibrin glue. Recently we operated on bank with pyeloplastic technique Y-V sec. Foley a kidney without pyelo-ureteral flow. After ureteral catheter removal, kidney scintigrafy show normal morphology and functionality of graft. Follow-up show a normal urinary flow and kidney function.