Purpose: Urinary fistula and ureteral stenosis occur respectively in 2-5% and 2-7.5% after kidney transplantation. Within the different causes of stenosis and fistula after kidney transplantation, ischemic diseases of the complex blood supply of the ureter are usually involved. The lack of viable distal ureter impels the surgeon to use the native urinary tract for the reconstruction. We analyzed the outcome and complications where end-to-end ureteral anastomosis with native ureter ligation was performed, without nephrectomy of the correspondent kidney at the same time.

Methods: 1,921 renal transplant recipients from January 2005 through October 2014 were reviewed. Patients with urinary fistula were identified. Patients submitted to ligation of native ureter and end-to-end anastomosis for ureterostomy, without nephrectomy of the native kidney were accessed. Parameters analyzed comprised: age, pre-operative diuresis, comorbidities, delayed graft function, previous stenting, early and late complications,renal function, graft survival and interval between renal transplant and reconstructive surgery. Charts were reviewed for pyelonephritis, flank pain and the need for native nephrectomy.

Results: Urinary fistula after renal transplant was observed in 51 cases (2.65%). In this group 45 (88.23%) cases were managed with surgery:nefrostomy in one case (1,96%), pyeloureterostomy in 2 cases (3,92%), reimplant in 19 cases (37,25%), end-to-side anastomosis ureterostomy in 11 cases (21,56%) and in 12 cases (23,53) were treated with ressection of ureteral isquemic segment of transplanted kidney, ligation of native ureter and end-to-end anastomosis for ureterostomy, without nephrectomy of the native kidney. Mean age was 48 years (range 65-27). Mean diuresis was 380 cc/day (range 0-1500 cc/day). Mean interval between renal transplant and surgery was 17 days (6-30). Two out of 12 patients (16.66%) required native nephrectomy at one and four months after transplantation due to urinary tract infections. One patient was anuryc and the other had 300 cc output of urine previous to the renal transplant. Mean follow-up was 46.18 (2 – 103) months.

Conclusions: Ligation of native ureter and end-to-end anastomosis for ureterostomy, without nephrectomy of the native kidney may be a safe option. Larger series are needed to evaluate risk factor for poor outcome and complications.

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