Renal autotransplantation for managing a short upper ureter or after ex vivo complex renovascular reconstruction

Authors

  • J. Christopher Webster,

    Corresponding author
    1. Division of Urology, Department of Interdisciplinary Oncology and Surgery, and Lifelink Transplant Institute, University of South Florida, Tampa, Florida, USA
      J. Christopher Webster, University of South Florida Division of Urology, Department of Interdisciplinary Oncology and Surgery Tampa Florida USA.
      e-mail: jwebster@hsc.usf.edu
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  • Jason Lemoine,

    1. Division of Urology, Department of Interdisciplinary Oncology and Surgery, and Lifelink Transplant Institute, University of South Florida, Tampa, Florida, USA
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  • John Seigne,

    1. Division of Urology, Department of Interdisciplinary Oncology and Surgery, and Lifelink Transplant Institute, University of South Florida, Tampa, Florida, USA
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  • Jorge Lockhart,

    1. Division of Urology, Department of Interdisciplinary Oncology and Surgery, and Lifelink Transplant Institute, University of South Florida, Tampa, Florida, USA
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  • Victor Bowers

    1. Division of Urology, Department of Interdisciplinary Oncology and Surgery, and Lifelink Transplant Institute, University of South Florida, Tampa, Florida, USA
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J. Christopher Webster, University of South Florida Division of Urology, Department of Interdisciplinary Oncology and Surgery Tampa Florida USA.
e-mail: jwebster@hsc.usf.edu

Abstract

Several topics related to the upper urinary tract are covered this month. Renal autotransplantation for managing a short upper ureter or after ex vivo complex renovascular reconstruction is described by authors from Florida. Percutaneous nephrolithotomy and various technical aspects associated with it are presented by authors from Germany and India.

OBJECTIVE

To report our contemporary experience with renal autotransplantation (AT), an established treatment for managing patients with a shortened ureter or renovascular disease, as despite its historical importance, AT remains an underused technique by urologists.

PATIENTS AND METHODS

All patients undergoing AT between 1997 and 2002 for a short ureter after ureteric injury and for renovascular disease were assessed by creatinine level and blood pressure before and after surgery, and antihypertensive drug use and complications.

RESULTS

Eleven patients had AT for renovascular disease and four for ureteric injury. There was no statistical difference in creatinine levels or blood pressure before and after surgery in either group. Eight patients treated with AT for renovascular disease required less antihypertensive medication after surgery. Minor complications occurred in both groups and included a suture abscess, chronic wound pain, and transient acute tubular necrosis. One patient in the ureteric injury group required a transplant nephrectomy after renal vein thrombosis, and one in the renovascular group died from multi-organ system failure.

CONCLUSION

AT remains a treatment option for patients with a short ureter after ureteric injury and in those with renovascular disease. Patients had stable renal function and blood pressure after surgery. Most patients treated for renovascular disease required less medication after AT. The procedure is associated with both minor and major complications, which must be considered before surgery.

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