Kidney transplantation in a patient with congenital anomalies of the lower urinary tract: difficult decisions — case study and review of literature

Abstract

Successful kidney transplantation (KT) is conditioned by a free flow of urine. In the case of patients with congenital anomalies of the urinary tract (UT) it is necessary to first correct anatomical barriers. If previous treatment is ineffective, KT is performed simultaneously with corrective surgeries. This report presents a case study of a patient who had undergone many urologic corrective procedures since early childhood due to UT congenital anomalies. During the patient’s qualification for KT, the catheterization of the bladder was unsuccessful. Consequently, it was suggested that the urine flow should be obtained by means of a Bricker’s loop created during the KT procedure or a suprapubic cystostomy, followed by urethral calibration. On the day of the transplantation procedure, the patient demanded an attempt to be undertaken to ensure a natural urine flow after KT. During the surgical procedure, the bladder was successfully catheterized with a Tiemann 10 catheter. Post-operative complications included a delayed graft function and the development of renal hematoma. The hematoma was removed and an open graft biopsy was performed simultaneously. A histopathology report of the biopsy tissue revealed features of the acute tubular necrosis (ATN). A USG examination detected pyelocalycectasis of the grafted kidney. Urethrotomy was performed twice and a revision of the ureterocystotomy was necessary to eliminate ureterostenosis. Presently, above 24 months after the KT, the patient is controlled by the Kidney Transplantation Centre in Olsztyn. The graft function is stable (creatinine level: 1.3 mg%), no episodes of urinary tract infections have occurred. The patient requires further close clinical control.