Saucedo-Crespo Hector, Myrmoe Anna, Hardie Kyler, Uzunlar Sena, Sakpal Sujit Vijay, Auvenshine Christopher
Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Surgery, University of South Dakota: Sanford School of Medicine, Sioux Falls, SD, USA.
Sanford School of Medicine: University of South Dakota, Sioux Falls, SD, USA.
Int J Surg Case Rep. 2023 Nov;112:108992. doi: 10.1016/j.ijscr.2023.108992. Epub 2023 Oct 26.
External bladder drainage with an indwelling transurethral catheter is standard during kidney transplant. Difficult Foley catheter placement is a frequent problem and one of the most common reasons for intraoperative urology consults. Suprapubic catheters are usually placed if retrograde urologic instrumentation options fail to cross the urethral obstruction. We report an alternative option with an antegrade-retrograde endoscopic approach.
This case illustrates a urethral rendezvous procedure applied successfully to traverse an occult mid-urethral stricture for Foley catheter placement during kidney transplantation in a 69-year-old diabetic man with end-stage renal disease and anuria.
The combined antegrade-retrograde rendezvous techniques have largely been described in the treatment of complex ureteric strictures more so than urethral strictures. This technique has not been described in the setting of a complex urethral stricture encountered during kidney transplantation. After utilization of the urinary tract rendezvous technique during kidney transplantation, our patient experienced an uneventful post-operative course with excellent renal allograft function.
The combined antegrade-retrograde urinary tract rendezvous technique is a feasible and safe technique that can help manage occult severe urethral strictures found at the time of kidney transplantation instead of suprapubic catheter placement when retrograde urologic instrumentation options fail to cross the obstruction.
肾移植期间，经尿道留置导管进行膀胱外引流是标准操作。Foley导尿管放置困难是一个常见问题，也是术中泌尿外科会诊最常见的原因之一。如果逆行泌尿外科器械操作无法越过尿道梗阻，通常会放置耻骨上导尿管。我们报告一种顺行-逆行内镜入路的替代方案。
本病例展示了一种尿道会师术，成功应用于一名69岁终末期肾病且无尿的糖尿病男性患者肾移植期间，用于穿过隐匿性尿道中段狭窄以放置Foley导尿管。
顺行-逆行联合会师技术在复杂输尿管狭窄治疗中的描述较多，而在尿道狭窄治疗中的描述较少。在肾移植过程中遇到复杂尿道狭窄的情况下，尚未有该技术的相关描述。在肾移植期间应用尿路会师技术后，我们的患者术后恢复顺利，肾移植功能良好。
顺行-逆行联合尿路会师技术是一种可行且安全的技术，当逆行泌尿外科器械操作无法越过梗阻时，可帮助处理肾移植时发现的隐匿性严重尿道狭窄，而无需放置耻骨上导尿管。
