Laparoscopic managment of ureteral stricture after kidney transplantation
Leonardo Romeo1, Adrián Berdeguer1, Rodolfo Fernández1.
1Urology and Kidney Transplantation. Hospital Español de Mendoza, Urocuyo, Mendoza, Argentina
Introduction: The development of ureteral strictures arises as one of the most challenging scenarios for transplant surgeons. Different strategies, from open reconstructive surgeries to minimally invasive approaches, may cope with this situation. In this work, we particulary we want to clarify the role of laparoscopy.
Method: We present the case of a 45 years old female, who had a kidney transplant surgery 15 years ago. During its regular check up, their clinician found a hydronephrosis of the graft that affected their kidney function. First, a nephrostomy tube was inserted to prevent further damagge and also to perform a pielography. A 2 cm ureteral stenosis prior to the ureterovesical juntion was diagnosed. Therefore, we offer a laparoscopic reconstructive surgery.
Results: A four-ports transperitoneal approach was attempted. At the beginning, the ureter was disected from craneal to caudal on its half lower portion. Then, bladder was release to gain flexibility. After a ureteral catheter was inserted from a lower lap port, an intravesical ureterovesical anastomosis similar to the Leadbetter technique was performed. Patient undergo a posoperative time without complications. At the moment, graft function is optimal.
Conclusion: We definitely believe that there is a window to increase the use of laparoscopy in the managment of ureteral strictures in renal allografts. A sharply determination of patient and disease characteristics is mandatory to improve posoperative results. Undoubdtedly, patient outcomes are strictly related to the experience in minimally invasive approaches.
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