Ron Shapiro, MD

Disclosures

December 02, 2003

Question

What do you do in the case of a short ureter or absence of a native ureter in kidney transplantation?

Manuel Melo y Escalante, MD

Response from Ron Shapiro, MD

This is really 2 or 3 different questions. In the case of a short donor ureter, it is relatively straightforward to anastomose the transplant ureter to the native ureter, either end-to-side or end-to-end; we routinely stent these anastomoses for 6 weeks. Occasionally, it may be necessary to remove the native kidney if one is performing an end-to-end reconstruction; but, in fact, it is generally agreed that this is usually not necessary, and in my experience, this has been the case.

If the transplant ureter is normal and the native ureter is not present, a standard ureteroneocystostomy would be sufficient. In the unusual circumstance where the transplant ureter is short and the native ureter is not present (I am not actually sure that I have ever seen this, to be honest), one could use the contralateral native ureter, or one could construct a Boari flap using the bladder.

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