Efficacy and safety of laparoscopic nipple-inserted ureteral bladder reimplantation for the treatment of ureteral stricture in kidney recipients / 中华泌尿外科杂志

ABSTRACT

Objective:To evaluate the safety and efficacy of laparoscopic nipple-inserted ureteral bladder reimplantation in the treatment of ureteral stricture in kidney recipients.Methods:Two patients with ureteral stenosis after kidney transplantation who underwent laparoscopic nipple-inserted ureteral bladder reimplantation in our hospital in November 2020 and May 2021 were retrospectively analyzed. Case 1, Female, 54 years old, the patient found mild hydronephrosis in the transplanted kidney 2 years before the operation. Ultrasound showed aggravated hydronephrosis 1 week before the operation, and the width of the renal pelvis was 2.9 cm. Nephrostomy was performed before the operation, and antegrade radiography showed that the ureteral anastomosis was narrow, about 2 cm in length, and the grade of ureteral stenosis in the transplanted kidney was grade 3. Case 2, Male, 56 years old, the patient was previously diagnosed with transplanted kidney hydronephrosis, ureterolithiasis and ureteral stricture, and had undergone percutaneous nephrolithotripsy for transplanted kidney and balloon dilatation for ureteral stricture. However, the hydronephrosis and calculus of the transplanted kidney recurred. One month before the operation, due to sudden anuria, a nephrostomy was performed in our hospital. Ultrasound indicated that the transplanted renal pelvis was dilated, and the width of the renal pelvis was 3.1 cm. The grade of ureteral stricture of the transplanted kidney was grade 3. Both patients underwent transabdominal laparoscopy to dissociate and disconnect the ureter, and performed ureteral papillaplasty outside the abdominal cavity to complete ureteral reimplantation. Data on operation time, intraoperative blood loss, intraoperative and postoperative complications, and postoperative follow-up data were collected.Results:Both operations were successfully completed. The operation time was 145 and 180 minutes respectively. The intraoperative blood loss was 30 ml and 50 ml, respectively. The patient had no postoperative complications, and the renal function recovered compared with before. The double J tube was removed 12 weeks after the operation, and ultrasound showed that the width of the renal pelvis recovered to 0.8 cm and 1.1 cm respectively. The two patients were followed up for 18 and 12 months, respectively, and no recurrence of hydronephrosis was found.Conclusions:Laparoscopic nipple-inserted ureteral bladder reimplantation is a safe and effective method for the treatment of allograft ureteral stenosis, which has the advantages of minimally invasive, faster recovery, and fewer complications.