RESCUE OF RENAL-TRANSPLANTS WITH DISTAL URETERAL COMPLICATIONS BY PYELO-PYELOSTOMY

Secondary ureteroneocystostomy is the procedure most commonly used for repair of ureteral stenosis or necrosis in renal transplant patients. However, when the transplant ureter available for reconstruction is t oo short, ureteropyelostomy is the standard procedure. Another option is pyelo-pyelostomy, which has been used infrequently to date. Between 1979 and 1988 we managed 6 patients (4 men and 2 women 42 to 62 years old) with renal allografts who required repair of the transplant uret er for long segmented ureteral necrosis (3), long segmented ureteral s tenosis (2) and an iatrogenic lesion of the ureter (1) with pyelo-pyel ostomy. Of the 6 patients 2 had undergone previous rescue operations. Pyelo-pyelostomy with the renal pelvis of the graft was performed as f irst described by Gil-Vernet and Caralps in 1968. Median followup was 6 years (range 3 to 12 years). Two patients died of chronic rejection and pulmonary embolism, respectively. Four patients are still alive wi th functioning transplants and serum creatinine levels of less than 21 0 mu mol./l. According to our experiences with 6 patients, we believe that pyelo-pyelostomy is a promising rescue maneuver that is worth con sideration in cases of total or subtotal ureteral necrosis and long se gmented ureteral stenosis after renal transplantation.