Native Ureter Research Articles

The utility of native ureter in the management of ureteral complications in children after renal transplantation.

Ureteral complications after renal transplantation in children are a major source of morbidity. Management is complex and variable. With IRB approval, health records were retrospectively reviewed of patients who: were <18years, underwent kidney transplant between 1997 and 2017, had at least 2years of follow-up, and underwent interventions due to post-transplant ureteral complications. Of 136 patients, seventeen (13%) required ureteral intervention due to stricture (n=3), reflux (n=12), or both (n=2). Transplant occurred at median 10.5years (3.1-14.7). Reconstruction occurred at median 10months (7-15) after transplant. Pre-existing bladder pathology was present in 6 (35%) patients. Four of five patients with strictures had at least one endoscopic balloon dilation. Ultimate management included reimplantation, ureteroureterostomy of native to transplant ureter, pyeloureterostomy to native ureter, multiple endoscopic interventions followed by a Boari flap, or multiple failed endoscopic interventions. Fourteen patients with VUR underwent reimplantation (n=5), ureteroureterostomyof native to transplant ureter (n=4), pyeloureterostomyto native ureter (n=4), and one underwent endoscopic injection with Deflux of the transplant ureter. Only one patient had a non-functioning graft due to ureteral complication. All patients were alive at follow-up (median 17years [12-19]). Transplant ureteral reflux and stricture are significant complications following pediatric renal transplantation and may require surgical management. In our population, reflux or stricture requiring ureteral reconstruction occurred in 10% and 4%, respectively. Endoscopic interventions were rarely successful. Native ureters were used for ureteral reconstruction in more than two thirds of patients should be considered in management of ureteral complications.

Robot-assisted Transplant Ureteral Repair to Treat Transplant Ureteral Strictures in Patients after Robot-assisted Kidney Transplant: A Case Series

To describe the use of robotic-assisted transplant ureteral repair (RATUR) for treating transplant ureteral stricture (TUS) in 3 patients who had undergone robot assisted kidney transplant (RAKT). We reviewed the medical records of 3 patients who experienced TUS after RAKT and who underwent RATUR between 2017 and 2020. The patients' RAKT, post-transplant clinical course, endourological interventions, reoperation, and recovery were assessed. All patients diagnosed with TUS presented with deterioration of kidney function after RAKT. Method of diagnosis included ultrasound, antegrade ureterogram, and CT scan. All 3 patients had a short (<1 cm) area of TUS and underwent RATUR. For 2 patients, distal strictures were bypassed with modified Lich-Gregoir ureteroneocystostomy reimplantation. One patient was treated with pyelo-ureterostomy to the contralateral native ureter. No intraoperative complications, conversions to open surgery, or significant operative blood loss requiring blood transfusion for any patient were observed. Also, no patients had urine leaks in the immediate or late postoperative period. After RATUR, 2 patients developed Clavien grade II complications with rectus hematoma or urinary tract infection. RATUR is a technically feasible operation for kidney transplant patients with TUS after RAKT. This procedure may provide the same benefits of open operation without promoting certain comorbidities that may occur from open surgical procedures.

Mesenchymal stromal cell treatment of donor kidneys during ex vivo normothermic machine perfusion: A porcine renal autotransplantation study.

Normothermic machine perfusion (NMP) of injured kidneys offers the opportunity for interventions to metabolically active organs prior to transplantation. Mesenchymal stromal cells (MSCs) can exert regenerative and anti-inflammatory effects in ischemia-reperfusion injury. The aims of this study were to evaluate the safety and feasibility of MSC treatment of kidneys during NMP using a porcine autotransplantation model, and examine potential MSC treatment-associated kidney improvements up to 14days posttransplant. After 75min of kidney warm ischemia, four experimental groups of n=7 underwent 14h of oxygenated hypothermic machine perfusion. In three groups this was followed by 240min of NMP with infusion of vehicle, 10million porcine, or 10million human adipose-derived MSCs. All kidneys were autotransplanted after contralateral nephrectomy. MSC treatment did not affect perfusion hemodynamics during NMP or cause adverse effects at reperfusion, with 100% animal survival. MSCs did not affect plasma creatinine, glomerular filtration rate, neutrophil gelatinase-associated lipocalin concentrations or kidney damage assessed by histology during the 14days, and MSCs retention was demonstrated in renal cortex. Infusing MSCs during ex vivo NMP of porcine kidneys was safe and feasible. Within the short posttransplant follow-up period, no beneficial effects of ex vivo MSC therapy could be demonstrated.

Perfect outcome of kidney recipients with ureteral stenosis after treatment with open surgery under magnetic resonance urography localization.

BackgroundTo evaluate the outcome of kidney recipients with ureteral stenosis after treatment with open surgery under magnetic resonance urography (MRU) localization.MethodsWe assessed 2,256 consecutive kidney transplant recipients between October 2010 and December 2018. Ureteral stenosis was detected by ultrasound, confirmed and positioned by Magnetic Resonance Urography. All patients underwent open ureteral reconstruction. The ureteral stenosis was located according to the location on the MRU during the operation. Surgical complications and recurrence rate were recorded in the stenosis group. Outcomes were compared with those of a matched control group of transplant recipients with no history of ureteric stenosis.ResultsThe incidence of ureteral stenosis in our center was 3.1% (70/2,256). Sixty-four cases (91.4%) were confirmed to have distal stenosis and were reconstructed with ureterovesical re-implantation; six cases (8.6%) were confirmed to have mid-distal stenosis and were subjected to ureteroureterostomy with the use of native ureter. The overall success rate was 100% and the graft function was salvaged in all cases. There was no recurrence of stenosis after a mean follow-up of 38.9±26.3 months. The complication rate was 5.7%. The 110-month graft survival and patient survival were not significantly different between the stenosis and control groups.ConclusionsMRU is an effective method for non-invasive and accurate diagnosis of ureteral stenosis in kidney transplant recipients. Open ureteral reconstruction surgery under MRU localization for treatment of ureter stenosis after kidney transplantation had a high success rate, low recurrence rate and high safety.

Native Ureter Ventriculo-Ureteral Shunt Placement for Management of Refractory Hydrocephalus in a Child With a History of Renal Transplant: Case Report and Technical Note

This report describes the case of a 5-year-old male with intractable hydrocephalus secondary to neonatal intraventricular hemorrhage who was ultimately managed with the placement of a ventriculo-ureteral (VU) shunt. He had previously failed numerous attempts at cerebrospinal fluid shunting, choroid plexus cauterization, and endoscopic third ventriculostomy. The patient had a history of end stage renal disease, and had previously undergone renal transplant. In an operation that involved Neurosurgeons, Pediatric Urologists, and Transplant surgeons, a Gibson incision was used to avoid the patient's multiple intra-abdominal adhesions, and his nonfunctioning renal unit was used to implant a VU shunt without early or late complications.

Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review

Ureteroplasty using onlay grafts or flaps emerged as an innovative procedure for the management of proximal and midureteral strictures. Autologous grafts or flaps used commonly in ureteroplasty include the oral mucosae, bladder mucosae, ileal mucosae, and appendiceal mucosae. Oral mucosa grafts, especially buccal mucosa grafts (BMGs), have gained wide acceptance as a graft choice for ureteroplasty. The reported length of BMG ureteroplasty ranged from 1.5 to 11 cm with success rates of 71.4%-100%. However, several studies have demonstrated that ureteroplasty using lingual mucosa grafts yields better recipient site outcomes and fewer donor site complications than that using BMGs. In addition, there is no essential difference in the efficacy and complication rates of BMG ureteroplasty using an anterior approach or a posterior approach. Intestinal graft or flap ureteroplasty was also reported. And the reported length of ileal or appendiceal flap ureteroplasty ranged from 1 to 8 cm with success rates of 75%-100%. Moreover, the bladder mucosa, renal pelvis wall, and penile/preputial skin have also been reported to be used for ureteroplasty and have achieved satisfactory outcomes, but each graft or flap has unique advantages and potential problems. Tissue engineering-based ureteroplasty through the implantation of patched scaffolds, such as the small intestine submucosa, with or without cell seeding, has induced successful ureteral regeneration structurally close to that of the native ureter and has resulted in good functional outcomes in animal models.

The Efficiency and Safety of Endoscopic Treatment on Kidney-Transplanted Patients With Symptomatic Vesicoureteral Reflux in Native and Transplanted Renal Units

ObjectivesTo evaluate the outcome of endoscopic treatment of symptomatic vesicoureteral reflux (VUR) in patients with VUR in both transplanted and native renal units. Material and MethodsBetween January 2014 and December 2019, 23 transplanted patients with symptomatic VUR with reflux in both transplanted and native kidney were included in the study. All patients were patients with a history of kidney failure due to reflux nephropathy. A voiding cystourethrography was performed after at least 1 episode of acute glomerulo pyelonephritis or deterioration of the graft function. All patients underwent a urine culture and an ultrasonic evaluation preoperatively. A dextranomer/hyaluronic acid bulking agent was injected via endoscope by a rigid metal needle around a double J stent. Clinical success was defined as absent of febrile urinary tract infection during the follow-up period. ResultsThe procedure was applied in 52 effected renal units; of these, 27 were transplanted kidneys, and 25 were native kidneys. Overall clinical success was achieved in 69.6% (N = 16) of patients. The success rate after the first procedure was 52.2% (N = 12), whereas 17.3% (N = 4) achieved success after the second treatment. No intraoperative complications occurred throughout the endoscopic procedure. Minor postoperative complications included 2 (10%) cases of self-limiting episodes of hematuria that did not require intervention. ConclusionEndoscopic treatment of symptomatic VUR for both transplanted ureter and native ureter is a safe treatment in most of the patients. Therefore, endoscopic ureteral injection is a treatment modality with low morbidity that should be preferred to open surgery as first-line treatment in this subgroup of patients.

Fused Supernumerary Kidney Presenting as Total Urinary Incontinence

Supernumerary kidney, a rare congenital anomaly, defined as an additional kidney with a separate capsule, collecting system and blood supply draining into the native ureter or a separate ureter. Small fused supernumerary units may be difficult to differentiate from renal moiety with complete separate ectopic ureter without complete evaluation. We report a case of a supernumerary kidney fused with the capsule of ipsilateral kidney with a separate complete ureter draining into the introitus of a young female thereby presenting as total incontinence of urine.

PD22-05 RENAL TRANSPLANTATION INTO URINARY DIVERSIONS AND RECONSTRUCTED BLADDERS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I (PD22)1 Apr 2020PD22-05 RENAL TRANSPLANTATION INTO URINARY DIVERSIONS AND RECONSTRUCTED BLADDERS James Chong*, Rhana Hassan Zakri, Muhammad Shamim Khan, C Geoff Koffman, Nizam Mamode, and Jonathon Olsburgh James Chong*James Chong* More articles by this author , Rhana Hassan ZakriRhana Hassan Zakri More articles by this author , Muhammad Shamim KhanMuhammad Shamim Khan More articles by this author , C Geoff KoffmanC Geoff Koffman More articles by this author , Nizam MamodeNizam Mamode More articles by this author , and Jonathon OlsburghJonathon Olsburgh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000872.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal failure secondary to urological disorders can necessitate urinary diversion or reconstruction either pre or post-kidney transplant. Decision-making regarding timing of diversion/reconstruction may be affected by living (LD) or deceased (DD) donor options. We assessed our kidney transplant outcomes into urinary diversions and reconstructed bladders. METHODS: Single-centre retrospective review of kidney transplants between 1986-2019. Graft and patient survival were calculated, and compared to our general transplant population. RESULTS: 87 patients (mean age 38.2) who had 97 transplants required urinary diversion or reconstruction. 80 of 97 were first transplants. Mean follow-up was 141 months. Cutaneous ureterostomy (CU): 18 transplants (8 LD; 10 DD); 16 CU formed at time of transplant. 1 patient required two sequential transplants; first was diverted to CU 3 years after transplant (for unrecognised neuropathic bladder), the second a planned CU. The other CU was formed 4 years post-transplant for a radiotherapy vesico-vaginal fistula from cervical cancer. Pre-formed ileal conduit (IC): 15 transplants into pre-formed IC (7 LD; 8 DD). 7 of 15 died during follow-up, 4 of 7 with functioning transplant in-situ. Post-transplant IC: 7 transplants into bladder (2 LD; 5 DD) but subsequent IC diversion (5 due to bladder cancer, 1 due to worsening bladder function from spina bifida and 1 from recurrent urosepsis). Reconstructed urinary tract: 57 transplants into augmented bladders using native ureter (4), gastric-segment (1), ileo-caecum (7) and ileum (45). 13 were augmented post-transplant; 2 were undiverted into neo-bladders post-transplant. CONCLUSIONS: Transplantation into urinary diversions and reconstructed bladders appears safe, with similar graft and patient survival to our general transplant population. There has been a significant increase in planned living donor transplant for patients with complex urinary tracts. DD kidney recipients with unsafe bladders may require initial CU before undiversion and reconstruction to prevent complications from a “dry” augment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e460-e461 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Chong* More articles by this author Rhana Hassan Zakri More articles by this author Muhammad Shamim Khan More articles by this author C Geoff Koffman More articles by this author Nizam Mamode More articles by this author Jonathon Olsburgh More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-14 IS THE END-TO-SIDE URETEROURETEROSTOMY SAFER THAN END-TO-END URETEROURETEROSTOMY FOR THE TREATMENT OF URINARY COMPLICATIONS FOLLOWING KIDNEY TRANSPLANTATION?

INTRODUCTION AND OBJECTIVE:Reconstructive surgery in ureteral complications are often challenging in kidney transplant. The use of the ipsilateral native ureter is a good alternative to a second ur...

Kidney transplantation using a colon pouch (Mainz pouch III): a case report

Kidney transplantation is the most efficient method of renal replacement therapy. When this method is performed, native urinary bladder is the preferred urinary reservoir. However, in some patients with an anatomically and functionally abnormal lower urinary tract, the urinary bladder cannot be used for transplantation. In these patients, urinary diversion should be performed before kidney transplantation. We present a case of a 32-year-old male patient with orthotopic kidney transplantation performed using a colon pouch (Mainz-pouch III). He was born with severe anomalies including sacral agenesis, anorectal atresia, and hypospadias, which were corrected during childhood. Neurogenic bladder with severe vesicoureteral reflux led to end-stage renal disease. This dysfunctional bladder was unsuitable for kidney transplantation, and a staged approach for future transplantation was chosen. The first step was the creation of urinary diversion. Due to a short appendix, we created a continent, colon pouch (Mainz pouch III). Two years later, orthotopic kidney transplantation was performed using a right cadaveric kidney. The renal vessels were anastomosed to the aorta and inferior vena cava and the pyelon to the native ureter. Four years after transplantation, the patient has stable renal function without any complications. This is the first documented case of using Mainz-pouch III as a reliable option for kidney transplantation in selected patients.

Robotic-assisted kidney transplant: a single center experience with median follow-up of 2.8years.

The main aim of the paper is to report a single-centre experience with RAKT, focusing on surgical, perioperative and functional outcomes at a median follow-up of 2.8years. Data of 26 RAKT patients was prospectively collected from December 2014 to February 2019 with follow-up of up to 55months. All donors were done laparoscopically. We followed Vattikuti-Medanta technique with modification of using pfannenstiel incision instead of Gelpoint and patient positioned in steep Trendelenburg position (30°) with leg split position. Hypothermia was maintained using a "modified graft hypothermia jacket". The engrafted kidney is oriented with the vessels being tagged with Prolene sutures. The mean BMI was 26.1 ± 4.7. The mean warm, cold and total ischemia times were 4.8 ± 1.1, 113.8 ± 20.9 and 118.7 ± 21.2min, respectively. Mean rewarming time was 62.5 ± 10min. The mean post-operative day (POD) 1, 3, 7, 30, 6months, 1 year and most recent creatinine was 3.4, 2.4, 1.8, 1.4,1.2, 1.2 and 1.69mg/dl. There was no case of delayed graft dysfunction (DGF) with graft survival of 1.8-55months. The mean GFR at POD 1, 1month and 1year was 24, 53.16 and 64.6. We had two intraoperative complications-one topsy turvy graft placement with anastomosis of donor ureter to native ureter and other had to be converted to open technique after anastomosis to control graft surface bleeding. Three postoperative complications-one patient has graft pyelonephritis which was managed conservatively with antibiotics. Two patients had lymphocele. One patient was managed with just aspiration while the other required laparoscopic de-roofing of the lymphocele. The mean hospital stay was 13.5 ± 3days. RAKT is feasible and safe only if performed by surgeons with appropriate background in robotic surgery and kidney transplantation after proper surgical training at experienced centres in the mid-term follow-up. Further studies need to confirm the long-term safety of RAKT.

Urologic issues in pediatric transplant recipients.

The limited supply of kidneys for pediatric transplantation leads to a large number of children in waiting transplant list. These patients have to be properly evaluated and prepared before organ transplantation to increase its success. The aim of this review is focus on urologic issues of pediatric kidney transplants such as preoperative evaluation and urinary tract abnormalities correction, surgical technique, and postoperative complications. All children that are candidates for kidney transplantation should be submitted to abdominal ultrasound. If bladder dysfunction is suspected, a more detailed evaluation is mandatory, including a voiding cystourethrography and urodynamic study. Patients with a poor bladder capacity and compliance will require bladder augmentation. Whenever possible the native ureter is recommended for that. Regarding kidney transplantation, recipient surgery can be safely performed through an extraperitoneal access, even in children weighting less than 10 kilograms. It allows adequate access to iliac vessels, aorta and vena cava. Graft survival continued to improve over the past decade and it is around 80% in 5 years. Postoperative complications such as urinary fistula may occur in less than 5% of cases, while vascular complications are reported in 1% to 2% of cases.

Minimally-Invasive Ureteral Reconstruction for Ureteral Complications of Kidney Transplants

ObjectiveTo present the technique, feasibility and results of minimally-invasive reconstruction of the transplanted ureter using the native ipsilateral ureter in post-transplant ureteral strictures and vesicoureteral reflux (VUR) causing graft pyelonephritis. Ureteral complications after kidney transplantation represent a significant cause of morbidity potentially leading to graft dysfunction or loss. MethodsA prospective database from October 2011 to August 2018 identified renal transplant recipients who underwent minimally-invasive pyeloureterostomies or ureteroureterostomies using the ipsilateral ureter. Indications for either transplant ureteral stricture or VUR correction were assessed. Preoperative evaluation included a technetium-99m mercaptoacetyltriglycine renal scan to assess residual native renal function and either a video cysto-urethrogram or cystoscopy and retrograde pyelography. Postoperative patency was evaluated with either cystograms or antegrade nephrograms in conjunction with a technetium-99m mercaptoacetyltriglycine study. ResultsSeven patients were followed with a mean follow-up time of 20.9 months (range 4.7-64.8 months). Three cases of VUR causing graft pyelonephritis and 4 cases of transplant ureteral stricture were identified. Five minimally-invasive transplant-to-native pyeloureterostomies and 2 transplant-to-native ureteroureterostomies were performed. Six cases were performed robotically and 1 laparoscopically. No recurrent episodes of pyelonephritis were observed for patients treated for VUR causing graft pyelonephritis. Postoperative renal scans and contrast studies demonstrated no evidence of obstruction or urinary leaks in all cases. ConclusionMinimally-invasive reconstruction of the transplant ureter by pyeloureterostomy or ureteroureterostomy using the ipsilateral native ureter is feasible and can be safely performed with graft survival and acceptable complication rates.

Posttransplant Urine Leakage with Extensive Ureteral Stricture Corrected by Pyelopyelostomy: A challenging case

Various rescue procedures have been devised to reconstruct a long-segment ureteral stricture with high-volume urinary leakage after kidney transplantation. Secondary pyeloureterostomy is typically employed using the recipient’s native ureter, and pyelopyelostomy is infrequently applied for secondary reconstruction. We used the latter method in a secondary transplant recipient whose native ureter was small in diameter and who also had a “frozen pelvis” with marked adhesions and fibrosis as he had survived various complications and multiple surgical procedures, including abscess drainages and colon surgeries. One and a half years have passed since the secondary pyelopyelostomy with a well-functioning graft; therefore, this open surgical repair appears to be the treatment of choice for complicated urinary leakage and failed endourological repair.

Native ureteroureterostomy in renal allograft recipient surgery: A single-center 5-year experience.

Introduction:In renal transplant, surgeons use a myriad of ureteral anastomotic techniques. Although ureteroneocystostomy (UNC) using Lich-Gregoir extravesical anastomosis is used most commonly, ureteroureterostomy with native ureter has its own importance in certain situations.Materials and Methods:We retrospectively reviewed records of patients who underwent renal transplantation at our center from March 2011 to February 2016. Records of patients who underwent ureteroureterostomy with the native ureter were reviewed for the indications and complications of the procedure.Results:Of 1050 renal transplants during the study period, 32 patients underwent native ureteroureterostomy. Among these 32 patients, 20 patients were planned preoperatively for native ureteroureterostomy (elective), and intraoperative decision was made in 12 patients (emergency). On follow-up, only one patient had ureteral obstruction due to kink just distal to ureteroureterostomy and was managed by double-J stenting. Other patients had an expected postoperative course.Conclusion:In our experience, ureteroureterostomy with native ureter is technically and functionally good option for ureteric reimplantation in kidney transplant patients. It can be used selectively for elective and emergency situations where UNC is not possible. Hence, the kidney transplant surgeon should be well versed with both techniques.

Feasibility of Laparoscopic Combined Para-Orthotopic Pancreas and Orthotopic Kidney Transplantation: Initial Research with a Pig Model.

BackgroundThe aim of this study was to investigate the feasibility of laparoscopic combined para-orthotopic pancreas and orthotopic kidney transplantation in a pig model.Material/MethodsTwelve white female pigs, (4–5 months old, weight range 40–45 kg) were used as donors and recipients, and 6 laparoscopic-combined pancreas and kidney transplantations were performed. After bilateral nephrectomy, the pancreatic artery and vein were anastomosed to the right renal artery and vein, respectively, and the pancreatic fluid was diverted to the duodenum or jejunum. The renal artery and vein were anastomosed to the left renal artery and vein, respectively. The ureter (or kidney pelvis) was anastomosed to the left native ureter (or kidney pelvis). The data of the operations were recorded, and grafts were inspected at autopsy.ResultsFour of the 6 recipient pigs underwent the entire procedure. The duodenum-to-duodenum anastomosis was unfinished in 1 case, and both the duodenum-to-duodenum and renal pelvis-to-pelvis anastomoses were left unperformed in another case. The mean recipient operative time was 429±43 minutes. The mean venous and arterial anastomotic times were 69±15 minutes and 37±18 minutes, respectively, for pancreas transplantation and 56±09 minutes and 42±06 minutes, respectively, for kidney transplantation. The time for renal pelvis-to-pelvis anastomosis was 56±13 minutes and for duodenum-to-duodenum anastomosis was 90±13 minutes. The mean blood loss for recipient pigs was 98±35 mL. An immediate viable blood supply was seen in the 4 pancreatic grafts and in the 5 kidney grafts during the operation by the appearance of a bright red color after revascularization. Five pancreatic grafts had autopsy-proven reliable artery anastomoses and 4 reliable vein anastomoses. All 6 kidney grafts had autopsy-proven reliable artery anastomoses; however, 1 had a vein anastomotic stricture.ConclusionsOur study showed that laparoscopic-combined para-orthotopic pancreas and orthotopic kidney transplantation in pigs is surgically possible.

The Impact of γ-Irradiation and EtO Degassing on Tissue Remodeling of Collagen-based Hybrid Tubular Templates.

Clinical implementation of novel products for tissue engineering and regenerative medicine requires a validated sterilization method. In this study, we investigated the effect of γ-irradiation and EtO degassing on material characteristics in vitro and the effect on template remodeling of hybrid tubular constructs in a large animal model. Hybrid tubular templates were prepared from type I collagen and Vicryl polymers and sterilized by 25 kGray of γ-irradiation or EtO degassing. The in vitro characteristics were extensively studied, including tensile strength analysis and degradation studies. For in vivo evaluation, constructs were subcutaneously implanted in goats for 1 month to form vascularized neo-tissue. Macroscopic and microscopic appearances of the γ- and EtO-sterilized constructs slightly differed due to additional processing required for the COL-Vicryl-EtO constructs. Regardless of the sterilization method, incubation in urine resulted in fast degradation of the Vicryl polymer and decreased strength (<7 days). Incubation in SBF was less invasive, and strength was maintained for at least 14 days. The difference between the two sterilization methods was otherwise limited. In contrast, subcutaneous implantation showed that the effect of sterilization was considerable. A well-vascularized tube was formed in both cases, but the γ-irradiated construct showed an organized architecture of vasculature and was mechanically more comparable to the native ureter. Moreover, the γ-irradiated construct showed advanced tissue remodeling as shown by enhanced ECM production. This study shows that the effect of sterilization on tissue remodeling cannot be predicted by in vitro analyses alone. Thus, validated sterilization methods should be incorporated early in the development of tissue engineered products, and this requires both in vitro and in vivo analyses.

Robot-assisted laparoscopic transplant-to-native ureteroureterostomy of an intraperitoneal renal allograft

The objective is to describe our experience with robot-assisted laparoscopic transplant-to-native ureteroureterostomy (UU) in a pediatric patient with an intraperitoneal renal allograft. We have previously demonstrated this technique for an extraperitoneal allograft. The patient is a 17-year-old female who had undergone a deceased donor renal transplant at 5 years of age. She developed acute kidney injury and hydronephrosis because of a ureteral stricture that developed after a right ovarian cyst excision. A retrograde pyelogram of her native ureter showed normal morphology. Her options were discussed and she proceeded with a robotic transplant-to-native UU. Robot-assisted laparoscopic transplant-to-native UU was performed via an intraperitoneal approach. The procedure time was 217min with an estimated blood loss of 10mL. Her postoperative course was unremarkable. After ureteral stent removal, her serum creatinine remained stable and follow-up imaging showed an improvement in hydronephrosis. Pediatric robot-assisted laparoscopic transplant-to-native UU for an intraperitoneal allograft is a technically feasible approach for the treatment of transplant ureteral strictures that combines the durability of open revision with the minimal invasiveness of endourologic management.

V02-09 LAPAROSCOPIC PYELO-URETEROSTOMY OF GRAFT KIDNEY TO NATIVE URETER FOR A POST TRANPLANT RECURRENT URETERAL STRICTURE

You have accessJournal of UrologyBPH, Male Voiding Dysfunction, and Transplantation1 Apr 2018V02-09 LAPAROSCOPIC PYELO-URETEROSTOMY OF GRAFT KIDNEY TO NATIVE URETER FOR A POST TRANPLANT RECURRENT URETERAL STRICTURE Jitendra Jagtap, Lokesh Sinha, Vinayak Kore, Vikash Kumar, Sachin Veer, and Pradeep Rao Jitendra JagtapJitendra Jagtap More articles by this author , Lokesh SinhaLokesh Sinha More articles by this author , Vinayak KoreVinayak Kore More articles by this author , Vikash KumarVikash Kumar More articles by this author , Sachin VeerSachin Veer More articles by this author , and Pradeep RaoPradeep Rao More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.468AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complicated recurrent ureteral strictures post renal transplantation have traditionally been managed by standard open surgical technique. We describe a successfully performed laparoscopic pyelo-ureterostomy between the graft kidney and native ureter for a long segment recurrent distal ureteral stricture in a 40 year old female. METHODS The patient had undergone a living related renal transplantation 3.5 years ago. She developed a distal ureteral stricture 3 years later and underwent an antegrade placement of a nephroureteral stent after balloon dilatation of the stricture. A month later she required an exploration, excision of distal ureteral strictured segment and ureteroneocystostomy for obstructive uropathy. Four months later she again presented with oliguria, rising creatinine and moderate hydroureteronephrosis. This time a laparoscopic pyelo-ureterostomy was performed using conventional three ports (two 10mm and one 5mm) triangulated towards the graft kidney. Intraoperative use of a 12MHz drop-in ultrasound probe aided in identification of the dilated graft pelvis and preoperative ureteral catheterisation helped in identification of right native ureter. Spatulated tension free anastomosis was performed with Polyglactin 4-0 sutures. RESULTS Operative time was 112 min with no intra operative complication. Postoperative course was uneventful. Hemoglobin drop was 0.2 gm/dL. Drain and catheter were removed on third postoperative day. Postoperative hospital stay was four days. Ultrasound on discharge showed resolution of the hydroureteronephrosis. DJ stent was removed after 15 days of surgery. CONCLUSIONS Laparoscopic pyelo-ureterostomy is a safe and efficacious technique for management of complicated recurrent ureteral strictures post renal transplantation. It additionally offers better comesis and shorter convalescence. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e169 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jitendra Jagtap More articles by this author Lokesh Sinha More articles by this author Vinayak Kore More articles by this author Vikash Kumar More articles by this author Sachin Veer More articles by this author Pradeep Rao More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...