One case of laparoscopic ureterovesicalre implantation in the treatment of ureteral
stenosis after
renal transplantation was reported, and related literatures was reviewed. A 54-year-old woman was admitted to our hospital with main complaint of
hydronephrosis of transplanted kidney for five years after
renal transplantation. Her physical examination showed slightly bulging in the transplanted kidney area without tenderness. The magnetic resonance urography (MRU) showed that the transplanted kidney and ureter were dilated obviously, with significant dilatation of renal pelvis and calyx, about 5 cm at the widest point of renal pelvis expansion, and the end of ureter was narrow, without abnormal filling defect in the ureter. The primary diagnosis was distal transplanted ureteral
stenosis. After twice endoscopic ureteral dilatation by multi-endoscopic technique, there was no improvement in the
hydronephrosis after the removal of the
stent. After thorough preoperative preparation, laparoscopic ureterovesical
reimplantation was performed under
general anesthesia. Firstly, the median umbilical ligament, the lateral umbilical ligament and the peritoneal fold were cut off, and the anterior bladder space was dissociated distally. The space of left side wall of the bladder and the pubic bone was gradually dissociated, and the space of anterior bladder wall and the pubic bone was dissociated. Secondly, the right side wall of the bladder was dissociated from the head to the tail, and the surrounding structure was carefully identified to avoid injury of the ureter of the transplanted kidney. The transplanted ureter was sought between the right side of the bladder and the lower pole of the transplanted kidney. The distal end of the ureter was cut open, and the narrow section was cut off, confirming that no
stenosis in the proximal ureter. The ureterocystic anastomosis was performed by Lich-Gregoir method (extra-bladder). Finally, the bladder tissue around the anastomosis site was fixed to the right pelvic wall to reduce tension.
RESULTS: The operation was completed successfully, the operation time was 210 min, the amount of
bleeding was about 30 mL, and there was no surgical complication. The
creatinine was stable after operation, with serum
creatinine declining to 68 μmol/L, and serum
creatinine 94 μmol/L before operation. The patient was discharged 5 days after operation. After follow-up of 3 months, KUB indicated that the position of ureteral
stent was good and the function of
renal transplantation was stable.
CONCLUSION: