Surgical management of renal neoplasm extending into the inferior veno cava / 中华泌尿外科杂志

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.

New biodegradable paclitaxel-eluting stents for repair of traumatic urethral stricture / 中华创伤杂志

Objective To evaluate the feasibility and effect of the new biodegradable paclitaxel-eluting stents in treatment of traumatic urethral stricture.Methods Twenty-five adult New Zealand rabbits were divided into study group (n =20) and control group (n =5) according to the random number table.In study group,rabbit models of traumatic urethral stricture were developed by self-designed explosive devices.All the stents were inserted under direct vision.Reparative results were evaluated by urethroscopy,retrograde urethrogram and histological examinations at postoperative 4,8,and 12 weeks.Results In study group all the stents were smoothly inserted into the strictured urethra without the occurrence of stent migration and lithogenesis.Urethroscopy showed that the stents in study group were partially degraded at 8 weeks,mostly degraded at 12 weeks and discharged with the urine.And from the naked eye,there was no distinct difference between the repaired and normal urinary mucosa.Retro~ade urethrogram demonstrated the stents restored urethral patency.Histological examinations showed the stents minimized stent-related inflammatory reactions,uroepithelial hyperplasia and scar formation.Conclusion New biodegradable paclitaxel-eluting stents exhibiting good biocompatibility are more effective to repair urethral stricture in rabbits.

In vitro study on the vaporization ratio of 2-mum laser in human prostatic tissue / 华中科技大学学报（医学）（英德文版）

In this study, the vaporization ratio of the 2-mum laser in the prostatic tissue with benign prostatic hyperplasia was examined in vitro, to explore a technique to estimate the clearance rate of prostatic tissue during the transurethral vaporesection of the prostate. A total of 9 fresh prostatic tissue specimens were obtained by open surgery and the wet weight of the prostatic tissue were measured immediately after the sample collection. Under the simulated conditions of transurethral vaporesection of the prostate by 2-mum laser, each prostate gland was completely vaporesected into fragments with a diameter of less than 1.0 cm in vitro. After the vaporesection, the whole fragments of prostatic tissue were collected and measured. Then the lost weight of prostatic tissue, the weight of the collected prostatic tissue and the ratio of the lost weight of prostatic tissue to the wet weight of the prostate glandular organ specimen were calculated. The correlation between the weight of collected prostatic tissue and the weight of the whole glandular organ was analyzed. All the experimental procedures were carried out by one operator. Wet weight of the prostatic gland specimen and the weight of the harvested prostatic tissues after the procedure were recorded. With respect to the wet weight of prostate gland specimen, the percentage of the weight of collected prostatic tissue was (34.45+/-1.51) %, and the percentage of the lost weight of prostatic tissue was (65.55+/-1.51)%. Satisfactory linear relationship was observed between the weight of collected prostatic tissue and the wet weight of prostate gland specimen [y=3.245x-6.475 (t=15.097, P=0.000)]. It is concluded that under the simulated conditions of transurethral vaporesection of the prostate by 2-mum laser, the vaporization ratio of prostatic tissue can be calculated on the basis of the weight of collected prostatic tissue, and thereby the clearance of prostatic tissue during the formal operation by 2-mum laser could be quantitatively determined.

Protective effect of biodegradable ureteral stent on renal function after traumatic ureter injury / 中华创伤杂志

Objective To establish a new canine model of ureter trauma to observe the protective effect of biodegradable ureteral stent on renal function following traumatic ureter injury. Methods A self-made device was used to make firearm fragment wounds unilaterally on the ureters in nine Beagle dogs (model group). The wounds were debrided and sutured and the results were evaluated by using intravenous pyelography (IVP) and radioactive renography at 40, 80 and 120 days postoperatively. Firearm fragment wounds were made to the bilateral ureters of nine Beagle dogs in the positive control group, in which a biodegradable stent was placed in one side and a double-J stent placed in the other side. Results In model group, hydronephrosis and hydroureter occurred and got worse postoperatively on the wounded side in all nine Beagle dogs, while none of these symptoms were found in any animals in the control group. The ratios of biodegradable stent side to double-J stent side were increased in renal patial concertration index and half time of kidney washout, but neither showed significant differences. However,vesicoureteral reflux (VUR) was not found in the biodegradable stent side, but in the double -J stent side. Conclusions A new canine model of firearm fragment wounds is successfully developed. Both the biodegradable and double-J stent play important roles in support and drainage and show no significant difference in aspects of renal uptake and half time of kidney washout. The biodegradable stent can effectively prevent VUR.

Two micron continuous wave laser vaporesection for treatment of large volume benign prostatic hyperplasia / 中华泌尿外科杂志

Objective To evaluate the efficacy of the RevoLix 70 Watt 2 micron continuous wave laser vaporesection for treatment of large volume benign prostatic hyperplasia(BPH,＞80 g).Methods Forty-five patients with obstructive BPH were treated with 2 micron continuous wave laser vaporesection.The age ranged from 57 to 88 years with a mean of 69 years.Nine patients had acute urinary retention.Mean prostatic volume was(96±1 3)ml(ranged from 80 to 128 m1).Eight cases were given suprapubic puncture.All cases were successfully anesthetized by using epidural anesthesia.At the beginning of the operation,the distal resection border close to the verumontanum was marked and laser incisions were performed at 5 and 7 o'clock lithotomy position.Firstly,median lobe was vaporeseeted closely along capsule from bladder neck to verumontanum.Secondly,prostate at 12 o'clock was vaporesected until the capsule was reached,and both lateral lobes were dissected downward.Thirdly,the apical position was enucleated by sheath,and then prostate was vaporesected from the tissue in 12 o'clock position to the tissue at 6.It was important to follow the 2 principles:inner to extra,up to down.Transfusion rate,resection time,time of indwelling catheter,improvement in urinary flow rate(Qmax),international prostate symptom score(IPSS)and quality of life(QOL)were measured.Results AIl cases were successfully operated.except one whose left lateral lobe was left due to heavy fluctuation of heart rate and blood pressure in operation.The mean operation time was (104±12)min.Transfusions were not necessary in any patients.The catheter was indwelled for 3 to 5 d postoperatively.One case had urethral stricture 3 weeks after operation,and urinated free after 22 times urethral sounding disj unctively.All cases were followed up for 3-1 2 months.All patients were satisfied with voiding outcome,none had incontinence.Mean Qmax increased from(3.3±0.5)ml/spreoperatively to(16.5±1.5)ml/s postoperatively.IPSS decreased from 28.6±5.5 to 8.3±2.3 and QOL score decreased from 4.5±0.4 to 2.7±0.2.respectively(P＜0.01).No hemorrhage occurred after the operation.Conclusion RevoLix 2 micron continuous wave laser vaporesection for treatment of large volume BPH is a safe and effective relief therapy,and that in combination with enucleation could improve the efficiency of vaporesection.

Percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava / 中华泌尿外科杂志

Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.

Use of phosphorylated-signal transduction and activators of transcription 3 in the early diagnosis of prostate cancer / 中华泌尿外科杂志

Objective To investigate the expression of Phosphorylated-signal transduction and activators of transcription 3 (P-STAT3) proteins in human prostate tissue from patients received re-peated biopsies. And consider the usefulness of detecting expression of P-STAT3 in early diagnosis of prostate cancer (PCA). Methods Fifty-eight patients (29 cases of PCA, and 29 cases of benign prostatic hyperplasia (BPH)) who had received repeated biopsies were involved in this study. Immu-nolabelling has been carried out on PCa patients' samples of cores from initially negative biopsies, typ-ical cores from cancer field, and other cores of the same batch biopsies showing no sign of prostate cancer. BPH patients' samples of cores from initial biopsies were set as control. All specimens were done immunohistochemistry stain with anti-P-STAT3 monoclonai antibody. The association of P-STAT3 expression in prostate tissues with the pathology result was evaluated. Results Compared with 10.3% in specimens of patients free of prostate cancer, the positive rate of anti-P-STAT3 stained in typical cores from cancer field, other cores of the same batch biopsies showing no sign of prostate cancer, and cores from initially negative biopsies, was 93.1 % (27/29), 82.8 % (24/29) and 86.2 % (25/29), respectively. There were significant differences of these values between former and laters' (X2=60.123,P=0.000). If P-STAT3 positive in tissue of initially biopsies was considered as the di-agnostic standard of prostate cancer, then it would show a relatively high sensitivity (86.2%) and specificity (89.7%). Conclusion IHC stain for P-STAT3 in prostate biopsy samples could be served as an adjunct to the current diagnostic approach to prostate biopsy for early diagnosis of pros-tate cancer.

Surgical excision of isolated local recurrence for renal cell carcinoma / 中华泌尿外科杂志

Objective To sum up experience with surgical excision of isolated local recurrence for renal cell carcinoma. Methods From March 2004 to November 2007, 7 patients (five cases un-derwent radical nephrectomy and two nephron-sparing surgery) with isolated local recurrence of renal cell carcinoma were treated at our department. All patients underwent extensive surgery for local re-currence. Results The mean patient age was 42 years (range 19 to 6). The mean time to local re-currence was 23.3 months (range 12 to 54). The Mean size of the recurrent tumor was 5.2 cm(range 2.5 to 10.5). Peritoneal exploration was performed in 7 patients and 5 had complete en bloc excision of the renal cell carcinoma mass. 2 patients gross disease was excised. The mean blood loss was 1050 (150-3000) ml. Surgical complications occurred in 2 patients, iliohypogastric nerve injure in one and ileus performation in another one. All patients recovered finally. Six patients were followed and one lost follow-up. Mean follow-up time was 13(8-27) months. One patient died of metastatic disease at 22 months after excision of the renal cell carcinoma mass. Conelusion En bloc excision of isolated locally recurrent renal cell carcinoma is possible, and complete surgical resection could lead to pro-longed disease-free survival.

Robot-assisted laparoscopic radical prostatectomy: report of 16 eases / 中华泌尿外科杂志

Objective To summarize the first 16 eases in mainland China and to discuss the cli-nical experience of robot-assisted laparoseopie radical prostateetomy(RLRP). Methods Sixteen pa-tients with localized prostate carcinoma underwent RLRP with da Vinci S surgical system (Intuitive Surgical Inc.). The age of the patients was 62-76 years, average 69 years. The preoperative t-PSA level was 0.2-79. 2. Ng/ml. The volume of prostate was 9.8-232.9 ml. Fifteen patients were with biopsy-proven prostate cancer, the average Gleason score was 7(4-9). Three were T2a. N0 M0, 4 were T2b N0 M0 and 8 were T2c N0/M0 by clinical stage. One was prostatic intraepithelial neoplasm-Ⅲ. The level of t-PSA in serum and the result of urinary continence were followed up after RLRP. Results All the operations were accomplished successfully. The mean preoperative set-up time of the da Vinci surgical system was 64(60--90)min;the mean operation time was 236(190--390)rain;the mean esti-mated blood loss was 231(50-500)m.L The patients were ambulant between the 2nd and 3rd postop-erative days. Foley catheter was sueeeasfully removed on day 10 to 14, and mean hospital stay was 13 (6-19) days. Two eases had positive surgical margins, the pathological stages were both pT3b N0 M0. The average serum t-PSA was less than 0. 1 ng/ml during a median follow-up of 9(6-12) months. By the conventional definition of urinary continence (0 to 1 pads daily), 94%(15/16) and 100% (16/16)of patients were continent at 3 and 6 months, respectively. Of the patients, 75% (12/16)and 88% (14/16)had no urinary leakage(0 pads daily). Conclusions RLRP is small incision and safe. It is the direction of minimally invasive urologic surgery.

Application of preoperative three dimensional helical CT assessment in retroperitoneal laparoscopic nephron-sparing surgery / 中华泌尿外科杂志

pful in decision making of retroperitoneal laparoscopic NSS.

Relation of pituitary tumor transforming gene expression changes and prostate cancer progression after the maximum androgen blockade therapy / 中华泌尿外科杂志

ssion of prostate cancer. Over-expression of PTTG and high Gleason grade are independent adverse predictors of pro-gression-free survival for patients with local or locally advanced prostate cancer.

Efficacy and safety of Bicalutamide 150 mg as the monotherapy in the treatment of locally advanced prostate cancer / 中华泌尿外科杂志

vides com-parable efficacy with medical castration in regard of decreasing PSA level and reducing prostate vol-ume. It is a safe and well tolerated treatment option as well.

A simplified technique for laparoscopic ureteroneocystostomy without ureteral nipple or submucosal tunneling / 中华泌尿外科杂志

Objective To present the preliminary experience with laparoscopic ureteral reimp1ant for distal ureteral stricture without everted ureteral nipple or submucosal tunneling. Methods Six patients with distal ureteral stricture underwent transperitoneal laparoscopic ureteral reimplantation.The ureteral was reimplanted into the bladder without everting the ureter or without a tunnel.The seromuscular wall of the ureter was anastomosed eircumferentially to the bladder muscle layer by continuous suture. Results All procedures were successfully performed without any intraoperative complications or need for open conversion.Intravenous urography showed normal drainage without obstruction or reflux during follow-up. Conclusion Laparoscopic ureteral reimplantation might be technically simple and feasible.

Hemostatic techniques during laparoscopic nephron-sparing surgery / 中华泌尿外科杂志

Objective To investigate the efficacy and safety of the hemostatic techniques applied during the laparoscopic nephron-spring surgery in the treatment of renal tumor. Methods Twentytwo male and 8 female patients with renal tumors underwent laparoscopic nephron-sparing surgery by using the hemostatic techniques of harmonic scalpel, bipolar cautery and renal parenchyma defect suturing over surgical bolsters. Among them, 4 cases have been done transperitoneally and others have been done retroperitoneally. The mean patient age was 50 years. Of the 30 cases, 20 had renal cell cancers with a mean diameter of 2.5 cm, and 10 had renal angiomyolioma with a mean diameter of 2.4 cm. The operating time, estimated blood loss, length of postoperative hospital stay, complications and surgical results were recorded. Results All procedures were successfully completed. No case had converted to open surgery. The mean operating time was 169min and mean estimated blood loss was 100 ml. Major complications happened in 2 patients. One of them had accepted transfusion during surgery. Another case had retroperitoneal hemorrhage three days after surgery and had been treated with 800 ml blood transfusion. The mean post-operative hospital stay was 9 days. During the mean 9 month follow-up, no patient had local or trocar port site recurrence.Conclusion The hemostatic techniques of harmonic scalpel, bipolar cautery, renal parenchyma defect suturing over surgical bolsters could be effectively and safely applied in the laparoscopic nephron-sparing surgery.

Role of an inhibitory receptor LAIR-1 expression in graft rejection / 中华器官移植杂志

Objective To investigate the relationship between the soluble LAIR-1(sLAIR-1)in the serum from recipients after transplant and graft rejection.Methods Serum sLAIR-1 level was determined by double mAb sandwich enzyme linked immunosorbent assay on 23 cases of liver transplantation and 139 cases of kidney transplantation.Results In healthy volunteers and 98 recipients with normal graft function,sLAIR-1 was detected at low level [(4.3±2.3)μg/L and(6.3±3.7)μg/L],with the difference being not significant.In 6 cases of liver acute rejection,20 cases of kidney acute rejection and 5 cases of graft loss,serum sLAIR-1 levels were increased remarkably at high 1evels [(47.2±25.9)μg/L,(36.3±14.7)μg/L,and(28.8±9.4)μg/L respectively]as compared with the two groups of healthy volunteers and the recipients with normal graft function,even peaked at 117.3 μg/L in one case of severe liver rejection.Meanwhile,in 5 cases of liver chronic rejection,27 cases of kidney chronic rejection and 6 cases under dialysis treatment.the levels of sLAIR-1 were(16.1±6.4)μg/L,(13.1±5.5)μg/L and(11.2±4.6)μg/L respectively,significantly higher than those of the healthy volunteers and the recipients with normal graft function.Conclusion sLAIR_1 was detected at high level in the recipients suffered graft acute or chronic rejection and might be a promising monitor of rejection after transplantation.

Clinical study of minocycline combination with pulse microwave for treatment of chronic prostatitis / 中国医师进修杂志

Objective To investigate the effect of combined treatment of microwave and antibiotics for chronic prostatitis. Methods A total of 90 patients with the diagnosis of chronic prostatitis were divided into two groups. The study group (n=45) received combined treatment of pulse microwave and minocycline, and the control group(n=45)only received the minocycline therapy. Results The curative effect of the study group was much better than that of the control group after a therapy of 5 weeks, based on the NIH-CPSI and the counting of WBC in prostate fluid. Conclusions Combined treatment of pulse microwave and minocycline is effective to ameliorate the symptoms of pain and dysuria, increase the quality of lives, decrease the counting of WBC in the prostate fluid. Therefore it is a useful treatment to improve the rate of cure and utility.

Three managements of bladder tumors under cystoscopy / 医疗卫生装备

Objective To discuss three managements of bladder tumors under cystoscopy.Methods Of all the patients,1174 were injected compound aluminum sulphate in tumor pedicle,and 700 cases were treated with transurethral resection of bladder tumor (TURBT) and 34 cases were treated with holmium laser.Results The first management,without obturator nerve reflex and tumor recurrence in situ,was easy and economical but not fit for big tumors without pedicles.With the requirements for related techniques and equipments,TURBT might be accompanied by bleeding,obturator nerve reflex and tumor recurrence in situ.Of the 34 cases treated with holmium laser,there were 3 ones with ectopic recurrence and no one with recurrence in situ.With the requirement for holmium laser equipment,the third management was the most expensive one.Conclusion All of the three managements have their advantages and disadvantages.The doctor should select the right management or perform cross application according to the condition of the patient.

Clinical analysis of 7 cases of adult prostate sarcoma / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis, treatment and prognosis of adult prostatic sarcoma.</p><p><b>METHODS</b>The records of 7 patients with prostate sarcoma were reviewed in the light of clinical manifestation, laboratory examination, therapeutic methods and histological subtypes. Several clinicopathological variables were assessed for prognostic significance.</p><p><b>RESULTS</b>Of the 7 cases, 3 were leiomyosarcoma, 3 rhabdomyosarcoma and the other malignant neurilemoma. Most patients presented urinary obstruction, and the diagnosis of prostate sarcoma was established with ultrasound guided biopsy. Histological subtypes were related to the rate of survival. Two patients received radical cystoprostatectomy and died 13 and 21 months respectively after operation. Two cases underwent total pelvic exenteration, followed by chemotherapy and/or radiotherapy and still alive 15 months after operation. The other 3 received only chemotherapy and/or radiotherapy and died 7 months on average after diagnosis.</p><p><b>CONCLUSION</b>The long-term survival rate for adults with prostate sarcoma is low. Early diagnosis and complete surgical resection offer patients the best chance for survival. Long-term surveillance is necessary for the early detection of recurrence.</p>

Three-drug treatment for chronic prostatitis and curative effects in 80 patients / 第三军医大学学报

Objective To investigate the effectiveness of three-drug (Relingqing, Prostant and Antibiotic) therapy to chronic prostatitis. Methods One hundred and twenty patients were randomly divided into 2 groups: three-drug treatment group (n=80) and antibiotic only group (n=40). After treated for 12 weeks, 120 cases of chronic prostatitis were evaluated with the pre- and post-massage test (PPMT) and chronic prostatitis symptom index (CPSI). Results In three-drug treatment group, 15 patients in 21 patients of type Ⅱ and 41 patients in 59 patients of type ⅢA were normal evaluated by PPMT. From the results of CPSI, the cure rate was 13.8% (11 cases), the symptoms of 48 patients (60.0%) were improved significantly whose CPSI decreased more than 15, and only 16 patients(20.0%)felt a little better whose CPSI decreased from 5 to 15, and the symptoms of 5 patients were not improved. There was statistical difference among three-drug treatment group and antibiotic only group. Conclusion The three-drug treatment is more effective in treating chronic prostatitis than the therapy of antibiotic only.

Diagnosis and treatment of complete necrosis of the ureter after cadaveric renal transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To deepen the understanding of patients with complete necrosis of the ureter after renal transplantation for early diagnosis and treatment.</p><p><b>METHODS</b>Of 5 patients with complete necrosis of the ureter after renal transplantatioin between January 1991 and April 2001 in our hospital, 4 were male and 1 was female (mean age, 35 years). Seven to 12 days after renal transplantation, native pyeloureterestomy was performed for 1 patient, and the remaining 4 patients received the cutting of the diatal necrosis ureter and vesicoureterostomy because of urine leakage. Six to seven weeks later when the ureter stents were pull out, native pyeloureterestomy or pyeloureteroplasty was performed for the 4 patients because of uropenia and hydronephrosis.</p><p><b>RESULTS</b>Five patients showed normal function of the kidney postopcreation (follow up: 6 - 12 months) without hydronephrosis.</p><p><b>CONCLUSIONS</b>When distal necrosis of the ureter is observed after renal transplantation, complete necrosis of the ureter may occur. Native pyeloureterostomy or pyeloureteroplasty is an effective treatment.</p>