Successful treatment of upper ureteral injury using renal autotransplantation

Daimantas Milonas, Saulius Stirbys, Mindaugas Jievaltas

Department of Urology, Kaunas University of Medicine, Lithuania

Key words: injury of the upper ureter; renal autotransplantation.

Summary. Introduction. Ureteral injuries are uncommon. Upper ureteral defect more than 7–8 cm in length is a challenge for urologists, requiring experience and several steps in its management. We report a case of iatrogenic upper urinary tract injury and successful treatment of 8-cm ureteral defect using autotransplantation of the kidney.

Case report. A male patient underwent surgery due to retroperitoneal tumor. Iatrogenic ureteral injury was recognized 18 days after operation. Three-step management of urinary tract injury was performed. The first step included minimally invasive recovery of the urine flow and treatment of infection. The second step was unsuccessful renal descensus and new formation ureteropyeloanastomosis because of difficulties of kidney mobilization caused by previous surgery. The third step included a successful autotransplantation of the kidney and complete reconstruction of the urinary tract.

Conclusions. Autotransplantation can be successfully used for the management of long upper ureteral injury in referral urological centers.

Correspondence to D. Milonas, Department of Urology, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: daimantasmilonas@yahoo.com

Received 23 January 2008, accepted 7 December 2009