Successful long-term outcome utilizing existing native cutaneous ureterostomy for renal transplant drainage without ipsilateral native nephrectomy.

MANY RENAL transplant candidates with end-stage renal disease (ESRD) have bladder or ureterovesicular junction dysfunction, and without modification these candidates are considered to be poor candidates for renal transplantation (RT). Currently, many of these patients undergo urological reconstruction or repair before their transplant such as with ureteral undiversion to a previously dysfunctional bladder with bladder augmentation. These reconstructions seem to be associated with less morbidity compared to diversion procedures alone. However, for many patients undiversion or bladder augmentation is not an option, and they require urinary diversion prior to RT. One alternative proposed by Levitt, et al in 1979 is urinary diversion of transplanted kidneys through a cutaneous ureterostomy (CU). They reported two cases of successful utilization of the distal remnant of native cutaneous ureterostomy for an allograft transureteroureterostomy after native nephrectomy. However, many clinicians have been hesitant to utilize this technique of urinary diversion for fear of distal stenosis, stricture, and necrosis secondary to the fragile distal vasculature, and because the preoperative work-up and the procedure are often not always more simplified than the creation of a conduit. Both conduits and transuretero-ureterostomy (both require native nephrectomy) are often major surgical undertakings, thus a more simplified alternative would be welcome. One solution to these concerns is to forgo native nephrectomy and transplant the allograft ureter onto native cutaneous ureterostomy leaving the native kidney in place. The long-term experience with use of a preexisting native CU via ipsilateral transplant ureteral native ureterostomy for transplant drainage without native nephrectomy is unreported. To determine the indications, complications, and efficacy of this procedure, we report our experience.