Experimental pyeloureterectomy and calyceal neck transection with autotransplantation and bladder advancement.

Br J Urol 1998 Dec;82(6):877-81

Department of Urology, Royal Brisbane Hospital, Queensland, Australia.

Objective: To determine whether Dexon mesh, closely applied to the kidney, provides purchase for sutures to permit bladder/parenchymal apposition on autotransplantation and that, if this line of apposition were some distance from but surrounding renal papillae, urothelium would proliferate to cover exposed parenchyma to form a widely patent lumen; this should facilitate removal of the whole of an upper tract collecting system, retaining renal parenchyma alone.

Materials And Methods: To test this possibility and explore the practicability of the concept, nine dogs underwent bilateral nephrectomy followed by unilateral autotransplantation: the other kidney was discarded. Because the canine renal pelvis is intrarenal, the ureter was stretched maximally before passing fine scissors into the renal hilum to transect the collecting system as close to the kidney as possible in six of the nine dogs. In the remaining three dogs, partial nephrectomy was performed with division of the calyceal necks under vision. Thinned bladder wall was sutured to Dexon mesh some distance from the collecting tubules; omentum was applied to the suture line.

Results: Three dogs were killed prematurely at < 2 weeks because of perioperative complications. Four were killed at 2, 4, 5 and 8 weeks and two at 12 months. Dexon mesh proved to be an effective anchoring fabric, providing close apposition of bladder wall and parenchyma. There was no adhesion of the kidney to peritoneal contents. Urothelial proliferation to cover exposed parenchyma occurred early and by 12 months, a thin stroma was interposed between parenchyma and epithelium. The kidney was preserved in all but one removed electively, this dog having both cystitis and pyelonephritis at 12 months.

Conclusions: This study showed that autotransplantation of a kidney after removal of its collecting system and advancement of thinned bladder wall to renal parenchyma is practicable, with regenerated urothelium bridging the deficiency by covering exposed parenchyma, to create a widely patent lumen.
December 1998
9 Reads

Publication Analysis

Top Keywords

collecting system
bladder wall
exposed parenchyma
dexon mesh
thinned bladder
patent lumen
cover exposed
three dogs
autotransplantation kidney
renal parenchyma
pelvis intrarenal
parenchyma occurred
apposition bladder
renal pelvis
canine renal
wall parenchyma
close apposition

Similar Publications

Method and outcome of transvesical ureterectomy of the distal ureter in nephroureterectomy of native kidney upper tract urothelial carcinoma ipsilateral to a transplanted kidney.

Urology 2007 Jun;69(6):1045-8

Department of Urology, Chang Gung Memorial Hospital Kaohsiung, Kaohsiung, Taiwan.

Objectives: To analyze outcomes of cases in which we adapted a transvesical ureterectomy technique to remove the distal ureter, including complete removal of the bladder cuff, upon retroperitoneal nephroureterectomy (performed when the diseased native kidney and ureter are ipsilateral to the transplant kidney).

Methods: Nineteen cases of upper urinary tract urothelial carcinoma of the native kidney were diagnosed among the 520 kidney transplant recipients at our kidney transplantation clinic over the last 19 years. Of these 19 patients, 11 had urothelial carcinoma of the native kidney ipsilateral to the transplant kidney. Read More

View Article
June 2007

Partial nephrectomy and autotransplantation with pyelovesicostomy for renal urothelial carcinoma in solitary kidneys: a clinical update.

BJU Int 2007 May 19;99(5):1020-3. Epub 2007 Feb 19.

Department of Urology, St Antonius Hospital, Eschweiler, and University of Saarland, Hombérg/Saar, Germany.

Objective: To evaluate the indications and outcomes after partial nephrectomy and renal autotransplantation for urothelial cancer in solitary kidneys, with special attention to the ease of endoscopic tumour control after pyelovesicostomy.

Patients And Methods: In all, 978 records of three institutions were reviewed for patients undergoing partial nephrectomy between January 1990 and December 2000. Ex vivo organ-preserving surgery was used in selected patients with a solitary kidney and localized pelvic or calyceal tumour. Read More

View Article
May 2007

Evaluation of surgical models for renal collecting system closure during laparoscopic partial nephrectomy.

Urology 2005 Aug;66(2):451-4

Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.

Objectives: To evaluate the utility of the porcine and canine models for collecting system closure after partial nephrectomy involving violation of the renal collecting system. Advanced surgical technologies and novel techniques for performing laparoscopic partial nephrectomy are frequently evaluated in an animal model.

Methods: After evaluation of the upper urinary tract with retrograde pyelography, laparoscopic partial nephrectomy, including violation of the renal collecting system, was performed in 8 domestic pigs (group 1) and 2 dogs (group 2) with documented normal upper urinary tract physiology. Read More

View Article
August 2005

Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries.

Urology 2001 Oct;58(4):540-3

Department of Urology, University of California, San Francisco, School of Medicine, San Francisco, California 94143-0738, USA.

Objectives: To evaluate the efficacy of laparoscopic nephrectomy with autotransplantation in cases of severe proximal ureteral damage. Many patients with complex proximal ureteral injuries have good functional renal parenchyma and wish to salvage their kidney. Autotransplantation is a viable alternative to nephrectomy in these frustrating situations. Read More

View Article
October 2001