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V55 Endoscopic resolution of surgical challenges after kidney transplantation
V55
Endoscopic resolution of surgical challenges after kidney transplantation Eur Urol Suppl 2016;15(3);eV55
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Laso I.M., Gómez-Dos-Santos V, Duque-Ruiz G., Fabuel-Alcañiz J.J., Martinez-Arcos L., Díez-Nicolás V, Fernández-Alcalde A.A., HeviaPalacios V., Álvarez-Rodríguez S., Arias-Fúnez F., Burgos-Revilla F.J. Ramón Y Cajal University Hospital, Alcalá University, Dept. of Urology, Madrid, Spain INTRODUCTION & OBJECTIVES: Lithiasis, urinary fistula and tumoural pathology are post-transplant complications that sometimes can be managed endoscopically. RESULTS: Case 1: Transplant patient from a living donor, 37 years ago, who shows calcified lymphocele, secondary ureteral stricture and, as a complication, lithiasis in the pelvis and upper calyceal group. An open approach is performed, the ureter is dissected and the stricture identified. A ureterotomy is performed to allow the introduction of the flexible videoureteroscope. The lithiasis is found in the upper calyceal group, and removed with a Dormia catheter. Once assured there are no stones left, we proceed to a ureteral reimplantation. A security double J stent is inserted. Case 2: Patient with multiple ureteral lithiasis, associated dilation and little functional impact. A percutaneous antegrade access if performed, that allows to get into the ureter and the visualization of the lithiasis at the end of it. Fragmentation with Holmium laser. The ureter seen beyond the lithiasis is free of strictures. Placement of double J stent and withdrawal of the ureteroscope. Case 3: Transplant patient, 5 years ago, with hematuria. In the CT scan a pyelic tumour is seen in the graft. A ureteroscopy is performed and a tumour in the external margin of the renal pelvis is seen. A biopsy of the tumour is performed, corresponding to an undifferenciated urothelial carcinoma. Case 4: An upper calyceal group fistula is seen after transplant, already treated through direct suture. Endoscopically, we insert a 4 Fr catheter, and inject cyanoacrylate from the exterior to the calyceal system. The sealing of the fistula is shown in the pyelography. CONCLUSIONS: Regarding the renal graft, the endoscopic techniques are the best option of treatment in some cases, combining efficacy and low invasivity.
Endoscopic resolution of surgical challenges after kidney transplantation Eur Urol Suppl 2016;15(3);eV55
Print! Print!
Laso I.M., Gómez-Dos-Santos V, Duque-Ruiz G., Fabuel-Alcañiz J.J., Martinez-Arcos L., Díez-Nicolás V, Fernández-Alcalde A.A., HeviaPalacios V., Álvarez-Rodríguez S., Arias-Fúnez F., Burgos-Revilla F.J. Ramón Y Cajal University Hospital, Alcalá University, Dept. of Urology, Madrid, Spain INTRODUCTION & OBJECTIVES: Lithiasis, urinary fistula and tumoural pathology are post-transplant complications that sometimes can be managed endoscopically. RESULTS: Case 1: Transplant patient from a living donor, 37 years ago, who shows calcified lymphocele, secondary ureteral stricture and, as a complication, lithiasis in the pelvis and upper calyceal group. An open approach is performed, the ureter is dissected and the stricture identified. A ureterotomy is performed to allow the introduction of the flexible videoureteroscope. The lithiasis is found in the upper calyceal group, and removed with a Dormia catheter. Once assured there are no stones left, we proceed to a ureteral reimplantation. A security double J stent is inserted. Case 2: Patient with multiple ureteral lithiasis, associated dilation and little functional impact. A percutaneous antegrade access if performed, that allows to get into the ureter and the visualization of the lithiasis at the end of it. Fragmentation with Holmium laser. The ureter seen beyond the lithiasis is free of strictures. Placement of double J stent and withdrawal of the ureteroscope. Case 3: Transplant patient, 5 years ago, with hematuria. In the CT scan a pyelic tumour is seen in the graft. A ureteroscopy is performed and a tumour in the external margin of the renal pelvis is seen. A biopsy of the tumour is performed, corresponding to an undifferenciated urothelial carcinoma. Case 4: An upper calyceal group fistula is seen after transplant, already treated through direct suture. Endoscopically, we insert a 4 Fr catheter, and inject cyanoacrylate from the exterior to the calyceal system. The sealing of the fistula is shown in the pyelography. CONCLUSIONS: Regarding the renal graft, the endoscopic techniques are the best option of treatment in some cases, combining efficacy and low invasivity.