Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included several ureteral injury in 4 patients, failed supravesical diversion in 2,
renal carcinoma in a
solitary kidney in 1,
renovascular hypertension in 1 and donor arterial reconstruction before
renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe
inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal
autotransplantation and extracorporeal reconstruction can provide the best
solution for patients with severe renovascular and
ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located
tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for
renal transplantation. The role of
autotransplantation in the management of advanced renal
trauma and
calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.