Endoscopic incision for obstruction of vesico-ureteric anastomosis in transplanted kidneys

Authors

  • Zhaohui He,

    1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, and
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  • Xun Li,

    1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, and
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  • Lizhong Chen,

    1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, and
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  • Guohua Zeng,

    1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, and
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  • Jian Yuan,

    1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, and
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  • Wezhong Chen,

    1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, and
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  • Caixia Zhang

    1. Department of Urology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Xun Li, Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China.
e-mail: gdgzlx@21cn.com

Abstract

OBJECTIVE

To report our experience of endoscopic incision for obstruction of vesico-ureteric anastomosis (VUA) in transplanted kidneys.

PATIENTS AND METHODS

Between February 2001 and March 2006, six men and two women (mean age 38 years, range 27–57) with VUA obstruction in their transplanted kidneys were treated by percutaneous nephrostomy and endoscopic incision. After the anastomosis was completely cut, two JJ stents were placed in the ureter for 4–6 weeks. During the follow-up, serum urea, creatinine and uric acid levels were measured, and urine culture, ultrasound examination and washout renal scintigraphy were performed every month for the first 6 months, then every 3 months.

RESULTS

In all, 12 procedures of endoureterotomy were performed and all procedures resulted in successful incision of the obstruction. There were no complications during or after the procedures. The retrograde and antegrade endoureterotomies were performed with four procedures in two patients and eight procedures in six patients, respectively. At a mean (range) follow-up of 16 (4–45) months, five of the eight patients had ureteric patency and stable renal function. In three patients there was a recurrence of obstructive uropathy, immediately after JJ stent removal, which finally required open surgical correction.

CONCLUSIONS

Percutaneous nephrostomy and endoscopic incision is safe and effective for obstruction of VUA in transplanted kidney, and it can be the initial therapy for ureteric obstruction in transplanted kidneys; however, open surgical reconstruction should be considered if the initial endoscopic incision procedure fails.

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