Introduction

Short-or long-term ureteral complications such as vesicoureteral anastomotic stenosis or reflux occurring after renal transplantation remain a challenge. Even if pyeloureterostomy with the native ureter remains the surgical gold standard, different surgical and endourologic techniques are constantly being developed. We describe an original preperitoneal approach to vesicoureteral reanastomosis in renal transplant patients not eligible for endourologic treatment.

Methods

A JJ stent was inserted into the grafted ureter preoperatively. Surgery was performed by means of a Pfannenstiel incision. The extraperitoneal space surrounding the bladder was dissected and the distal part of the grafted ureter was easily identified and cautiously mobilized. The anastomotic area was removed and a new vesicoureteral anastomosis was performed, keeping the JJ stent in place for three weeks.

Results :

Seven kidney transplant patients benefited from this new preperitoneal approach because of anastomotic stenosis (n=4) or reflux (n=3). Postoperative course was uneventfull in all the patients. No stenosis or residual reflux were observed during the follow up (mean=9 months).

Conclusion

This new preperitoneal surgical approach has been shown save, easy and less invasive than the surgical technique involving the native ureter in kidney transplant patients not eligible for endourologic management.

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