For referring physicians
Transplant ureter stricture: the operations
Stricture of the transplant ureter with hydronephrosis and allograft dysfunction. What I need to know about how the kidney was put in, and the three operations, each with a video.
How does the kidney sit?
Before the operation I want the operative note from the transplant. Which donor kidney, left or right. Which iliac fossa it went into. How it was turned: whether the renal pelvis and ureter ended up in front of the vessels or behind them, and whether the ureter runs down to the bladder or was brought up. And which anastomosis was made: a refluxing or an anti-refluxing ureteroneocystostomy, or the transplant ureter joined to the native ureter.
See the transplant kidney and ureter in 3D: turn it, flip it, and change the anastomosis
Three operations
Transplant-to-native ureteroureterostomy, side to side, which preserves the ureteral blood supply. Ureteroneocystostomy, which I also do without transecting the ureter. And pyelovesicostomy, the bladder anastomosed directly to the renal pelvis. Concurrent ureteroscopy with near-infrared fluorescence finds the native and the transplant ureter quickly in a field that has been operated on, and all three can be done with the single-port robot.
Videos by operation
Most operative videos are age-restricted on YouTube, so you need to be signed in to watch them.
Transplant ureter to native ureter
Transplant ureter to bladder
Renal pelvis to bladder
The donor side
Papers
- Single-port robotic-assisted ureteral reconstruction for management of strictures after renal transplantation. Am J Transplant. 2023. PubMed 37330143
- Ureteral reimplantation via robotic nontransecting side-to-side anastomosis for distal ureteral stricture. J Endourol. 2020. PubMed 32233674
- Robotic ureteral reconstruction for recurrent strictures after prior failed management. BJUI Compass. 2023. PubMed 37025480