SALVAGE OF DIFFICULT TRANSPLANT URINARY FISTULAS BY ILEAL SUBSTITUTION OF THE URETER

We report our experience with 4 cases of ileal substitution of the ure ter after live-donor kidney transplantation and review the literature. The indications were recurrent ureteric fistula and obstruction in 3 cases and extensive necrosis of the ureter and renal pelvis in one cas e. Nephrostomy tube drainage was a useful adjunct to diagnosis and tre atment of the 4 cases. No mortalities or graft losses were encountered and satisfactory graft function was maintained 2-14 years after ileal substitution of the ureter. Moreover, no electrolyte or acid-base dis turbances were observed. One patient developed recurrent vesical stone s 2 and 4 years after ileoureteral replacement secondary to bladder ne ck obstruction. Ileal substitution of the ureter seems a feasible oper ation to salvage difficult and recurrent transplant urinary fistulae i n exceptional situations when it is impossible to restore urinary cont inuity using urinary tract tissues.