Bansal Amit, Kumar Anant, Maheshwari Ruchir, Desai Pragnesh, Chaturvedi Samit, Dassi Vimal
Department of Urology, Renal Transplant and Robotics, Max Super Specialty Hospital Saket, New Delhi, India.
Turk J Urol. 2021 Mar;47(2):151-157. doi: 10.5152/tud.2020.20371. Epub 2020 Oct 19.
Renal autotransplant (RA) is an underutilized procedure to treat major ureteric loss. Studies on long-term outcomes and follow-up after RA are scarce. This study aimed to report the long-term outcomes and follow-up after RA.
We identified 9 patients, from 2007 to 2019, who underwent RA after major ureteric loss (where direct restoration of continuity was not possible). We collected data regarding the etiology of ureteric loss, preoperative differential renal function, method of nephrectomy (laparoscopic or open), method of anastomosing the residual ureter/pelvis to the bladder, postoperative complications, duration of hospital stay, and renal function and drainage postoperatively and until the last follow-up. Changes in renal function and/or any obstruction to urinary drainage of the ipsilateral kidney postoperatively or during follow-up were measured. The Wilcoxon matched-pairs signed-rank test was used to compare the mean creatinine values preoperatively, postoperatively, and at last follow-up (p<0.05 was considered statistically significant).
All the patients had uneventful intraoperative and postoperative periods. The mean hospital stay was 6.4 (5-8) days. The median follow-up was 132 (46-156) months. The mean preoperative serum creatinine level was 1.0 (0.7-1.7) mg/dL. The mean creatinine value postoperatively and at last follow-up had no significant difference with preoperative value (p=0.96 and 0.75, respectively). The postoperative diethylene triamine pentaacetic acid scan demonstrated good perfusion and drainage. There was no deterioration of renal function or drainage during the follow-up.
RA is an excellent modality to treat major ureteric loss. It preserves renal function and avoids the problems related to bowel interposition and the need for long-term follow-up.
肾自体移植（RA）是一种治疗严重输尿管缺失但未得到充分利用的手术方法。关于RA术后长期疗效和随访的研究较少。本研究旨在报告RA术后的长期疗效和随访情况。
我们确定了2007年至2019年间9例因严重输尿管缺失（无法直接恢复连续性）而接受RA手术的患者。我们收集了有关输尿管缺失病因、术前患侧肾功能差异、肾切除术方法（腹腔镜或开放手术）、残余输尿管/肾盂与膀胱吻合方法、术后并发症、住院时间、术后直至最后一次随访时的肾功能和引流情况的数据。测量术后及随访期间患侧肾功能的变化和/或同侧肾脏尿路引流的任何梗阻情况。采用Wilcoxon配对符号秩和检验比较术前、术后及最后一次随访时的平均肌酐值（p<0.05被认为具有统计学意义）。
所有患者术中及术后过程均顺利。平均住院时间为6.4（5 - 8）天。中位随访时间为132（46 - 156）个月。术前平均血清肌酐水平为1.0（0.7 - 1.7）mg/dL。术后及最后一次随访时的平均肌酐值与术前值无显著差异（分别为p = 0.96和0.75）。术后二乙烯三胺五乙酸扫描显示灌注和引流良好。随访期间肾功能及引流均无恶化。
RA是治疗严重输尿管缺失的一种极佳方式。它能保留肾功能，避免与肠代输尿管相关的问题以及长期随访的必要性。
