[Challenging Case of Primary Renal Castleman's Disease Accompanied with Bacterial Pyelonephritis].

Castleman's disease is a rare lymphoproliferative disease, mostly found in the mediastinum. The number of Castleman's disease cases involving the kidneys is still limited. We report a case of primary renal Castleman's disease sporadically detected during a regular health check-up as pyelonephritis with ureteral stones. In addition, computed tomography showed renal pelvic and ureteral wall thickening with paraaortic lymphadenopathy. A lymph node biopsy was performed, but it did not confirm either malignancy or Castleman's disease. The patient underwent open nephroureterectomy for diagnostic and therapeutic purposes. The pathological diagnosis was renal and retroperitoneal lymph node Castleman's disease with pyelonephritis.

Predictors of mortality and nephrectomy in emphysematous pyelonephritis: a tertiary care centre study.

INTRODUCTION: Emphysematous pyelonephritis (EPN) is a deadly disease due to its associated morbidity and mortality. Attempts have been made to identify predictors of severity, mortality and need for nephrectomy in EPN with little success. METHODS: We conducted an ambispective study of EPN patients between March 2014 and September 2019. Retrospective data were collected which included age, sex, comorbidities, symptoms, signs, laboratory investigations including imaging, need for dialysis, management and any complications. All patients were then followed prospectively for renal dynamic scan, stone surgery or nephrectomy. Univariate analysis was performed to identify factors affecting mortality and need for elective nephrectomy. RESULTS: In total, 112 patients were included. Mean patient age was 50.01 years, 55% were female and 5% had bilateral involvement. Fever and flank pain were the most common symptoms. Diabetes was seen in 75% of cases and 30% of cases required haemodialysis at initial presentation. About 60% of patients improved with pigtail drainage. Need for nephrectomy was greater in Huang-Tseng stage 3a (14.8%). Huang-Tseng stages 3b and 4 had higher mortality rates (25%) than the other stages (2.2%). Twelve of 99 patients had non functional kidney on follow-up and underwent elective nephrectomy. Low platelet counts, high body mass index, septic shock, dialysis and higher Huang-Tseng stage were found to be predictive of mortality and renal parenchymal thickness on computed tomography scan was predictive of follow-up nephrectomy. CONCLUSIONS: Thrombocytopaenia, high body mass index, septic shock, haemodialysis and higher Huang-Tseng stage are predictors of mortality and renal parenchymal thickness <5mm is a predictor of poor salvage of affected kidney on follow-up.

Comparison of Percutaneous Nephrostomy and Ureteral DJ Stent in Patients with Obstructive Pyelonephritis: A Retrospective Cohort Study.

PURPOSE: Comparing the two different drainage methods of percutaneous nephrostomy (PCN) versus retrograde ureteral double - J (DJ) stent insertion in patients with obstructive pyelonephritis cases. MATERIAL AND METHODS: In this retrospective study, patients with obstructive pyelonephritis secondary to urolithiasis who underwent PCN or DJ insertion were included in the study. Patients were divided into two groups according to drainage method. After exclusion criteria, the study included 105 patients. The groups were compared for intraoperative outcomes, duration of fluoroscopy usage, the time needed for normalization of infection parameters (white blood cells (WBC), C - reactive protein (CRP), procalcitonin), and complications were observed. RESULTS: From 105 patients, 56 patients were in DJ stent group and 49 patients were in PCN group. According to intraoperative data, operative time and fluoroscopy duration were significantly shorter in the DJ ureteral stent group (P < .001). WBC returned to normal range in mean 3.5 ± 1.3 days in the DJ stent group and 3.2 ± 1.1 days in the PCN group (95% CI: -0.76-0.21, P = .268). There were no statistically significant differences identified for the duration for CRP, PCT and fever to return to normal range between the drainage methods. The complication rates was 51.8% for DJ stent group and, 30.6% in PCN group (P = .028). CONCLUSION: Both methods are effective and safe in obstructive pyelonephritis. Despite the higher complication rate in DJ stent group, these complications were minor.

Minimally invasive techniques as a first line approach in the management of emphysematous pyelonephritis - A single centre experience.

Context: Emphysematous pyelonephritis (EPN) is a dangerous necrotizing infection of the kidney involving the diabetics with a high case fatality rate. Recent medical literature has shown shifting of treatment strategy from conventional radical approach to minimally invasive approach. Aims: The aim of our study was to assess the role of minimally invasive stepwise decompression techniques in the management of EPN and preservation of the renal unit. Settings and Design: : This was a retrospective observational study conducted from June 2017 to April 2020 at a tertiary care centre. Material and Methods: We reviewed the hospital online records of 18 patients diagnosed with EPN for patient demographics, clinical profiles, co-morbidities, laboratory and, radiological investigations, surgical interventions performed and the outcomes. The severity of EPN was graded as per the Huang classification. Patients underwent surgical interventions as per the treatment protocol and response was assessed. Statistical Analysis Used: Descriptive statistics was applied. Results: Diabetes mellitus was present in 15 (83.3%) patients along with urinary tract obstruction in 8 (44.4%) patients. Flank pain (77.7%) was the most common presenting clinical feature while Escherichia coli (55.5%) were the most common causative organism. Most patients (50%) had Type- II EPN, all of which were managed successfully by minimally invasive procedures. In total seventeen patients (94.4%) responded well while one patient (5.5%) underwent nephrectomy with no mortality. Conclusions: Renal salvage in EPN requires multidisciplinary approach including the initial medical management followed by properly selected stepwise decompressive surgical techniques. Conservative management and decompression techniques have shown to improve patient's outcome, reducing the traditional morbidity associated with nephrectomy.

Graft Nephrectomy as Rescue Therapy for Posttransplant Rhizopus Pyelonephritis in a Pediatric Patient.

Rhizopus infection is an often-fatal complication after transplant. We present a 3-year-old pediatric patient with end-stage renal disease due to congenital hypoplastic kidneys who underwent deceased donor renal transplant. Approximately 3 months after transplant, the patient underwent renal biopsy for a presentation of fevers, acute kidney injury, and imaging evidence of hydronephrosis. The patient was found to have a Rhizopus infection of the transplanted kidney and underwent transplant nephrectomy. In addition to surgical debridement of the infection, the patient was treated with long-term antifungal therapy for complete eradication. After intervention, the patient has had no clinical or imaging evidence of residual or recurrent disease and has been reactivated on the transplant wait list. The positive outcome in this case highlights the importance of rapid diagnosis and treatment of a lethal complication.

Percutaneous Nephrostomy in the Neonatal Period: Indications, Complications, and Outcome-A Single Centre Experience.

PURPOSE: The purpose of this study was to evaluate the indications, technique for percutaneous nephrostomy (PCN) insertion, the complications related to PCN, duration of PCN, and outcome following PCN removal regarding the kidney function. MATERIAL AND METHODS: Medical charts of 31 neonates (22 boys and 9 girls, mean age 13.9 days) treated with 43 PCN were reviewed. Collected data included indications for PCN, PCN complications, duration of PCN, and outcome of these patients by analysing the kidney function. RESULTS: The indications for PCN insertion were obstructive urinary tract dilation in 24 neonates (four with associated infection), and non-obstructive urinary tract dilation with urosepsis or pyonephrosis in seven cases. Primary technical success of PCN placement using Seldinger technique was 97.7%. The following complications were reported: self-limited post-procedural bleeding into the pelvicalyceal system in two, chronic microscopic haematuria in five, and clinically manifested urinary tract infection in five children. Four PCN were dislocated. Cellulitis was present at the skin entry of 5 PCN, urinary leak in 5 PCN, and mechanical damage of 5 PCN. Eight PCN had to be replaced. Mean duration of PCN was 5 months. Kidney insufficiency was detected in 5/29 children with the mean follow-up of 3.9 years. CONCLUSIONS: PCN is a safe, effective transient solution in neonates with pyonephrosis or when surgery of obstructed urinary system has to be postponed. The rate of minor complications increased with PCN duration. If kidney insufficiency is present after PCN removal, it is related to the complexity of kidney anomalies.

Minimally-Invasive Ureteral Reconstruction for Ureteral Complications of Kidney Transplants.

OBJECTIVE: To present the technique, feasibility and results of minimally-invasive reconstruction of the transplanted ureter using the native ipsilateral ureter in post-transplant ureteral strictures and vesicoureteral reflux (VUR) causing graft pyelonephritis. Ureteral complications after kidney transplantation represent a significant cause of morbidity potentially leading to graft dysfunction or loss. METHODS: A prospective database from October 2011 to August 2018 identified renal transplant recipients who underwent minimally-invasive pyeloureterostomies or ureteroureterostomies using the ipsilateral ureter. Indications for either transplant ureteral stricture or VUR correction were assessed. Preoperative evaluation included a technetium-99m mercaptoacetyltriglycine renal scan to assess residual native renal function and either a video cysto-urethrogram or cystoscopy and retrograde pyelography. Postoperative patency was evaluated with either cystograms or antegrade nephrograms in conjunction with a technetium-99m mercaptoacetyltriglycine study. RESULTS: Seven patients were followed with a mean follow-up time of 20.9 months (range 4.7-64.8 months). Three cases of VUR causing graft pyelonephritis and 4 cases of transplant ureteral stricture were identified. Five minimally-invasive transplant-to-native pyeloureterostomies and 2 transplant-to-native ureteroureterostomies were performed. Six cases were performed robotically and 1 laparoscopically. No recurrent episodes of pyelonephritis were observed for patients treated for VUR causing graft pyelonephritis. Postoperative renal scans and contrast studies demonstrated no evidence of obstruction or urinary leaks in all cases. CONCLUSION: Minimally-invasive reconstruction of the transplant ureter by pyeloureterostomy or ureteroureterostomy using the ipsilateral native ureter is feasible and can be safely performed with graft survival and acceptable complication rates.

Laparoscopic nephrectomy in a patient with severe scoliosis: A case report.

Although the role of laparoscopic nephrectomy (LN) has been established, few studies have reported cases of LN in individuals with scoliosis. Here we report a case of right LN in a patient with severe right convex scoliosis. A 26-year-old man presented with a fever. His medical history comprised severe right convex lumbar scoliosis. CT revealed right hydronephrosis and right kidney stones. Pyelonephritis requiring nephrectomy was diagnosed. Right LN was feasible with elaborate perioperative care. The postoperative course was uneventful with no relapse of urinary tract infection.

Comparison between non-septic and septic cases in stone-related obstructive acute pyelonephritis and risk factors for septic shock: A multi-center retrospective study.

PURPOSE: This study assessed risk factors for septic shock in patients with obstructive acute pyelonephritis (APN) associated with upper urinary tract calculi in a multi-center retrospective study. METHODS: We studied 143 patients admitted to 4 hospitals in Japan with obstructive APN associated with upper urinary tract calculi. Data on gender, age, hypertension, diabetes, neurological disease or malignant disease, laboratory data (white blood cell (WBC) and C-reactive protein (CRP)), drainage, and bacterial strains including Escherichia coli in the non-septic and septic groups were collected. Risk factors for septic shock were analyzed by univariate and multivariate statistical analyses. RESULTS: There were a total of 107 non-septic cases (74.8%) and 36 septic cases (25.2%). The commonest strains of urinary tract infection-causative bacteria were E. coli in the non-septic group (23 cases, 21.5%) and septic group (13 cases, 36.1%) (p > 0.05). Emergency drainage was administered in 74.8% of the non-septic group and 97.2% of the septic group (p > 0.05). Meropenem was most often used as the initial treatment in the non-septic group (20 cases, 18.7%) and septic group (22 cases, 61.1%) (p < 0.0001). Risk factors for septic shock in multivariate analyses were diabetic mellitus (odds ratio (OR) = 3.591, p = 0.0098) and CRP ≥ 10 (OR = 1.057, p = 0.0119) as significant independent factors in this multicenter study. CONCLUSIONS: APN is a common infectious disease, especially in the cases with urinary tract obstruction where patients easily acquire bacteremia or sepsis. Stone-associated obstructed APN can cause fatal septic shock in cases with diabetes and CRP ≥ 10. Further prospective studies will be undertaken to draw definitive conclusions.

[Xanthogranulonatous pyelonephritis: report of 5 cases].

Xanthogranulomatous pyelonephritis (XGP) is an unusual form of chronic pyelonephritis in which the renal parenchyma is destroyed and replaced by lipid-laden foamy macrophages. It usually affects middle-aged women with a history of recurrent urinary tract infection, diabetes, or kidney stones. The inflammatory process is usually diffuse and can extend beyond the kidney. The rare focal forms may simulate primary renal tumours. The preoperative imaging diagnosis may be difficult. We reported five cases of XGP, The findings of ours were recorded including kidney size, shape, contour, the echogenecity of the renal parenchyma, the internal echoes of the dilate collecting system, the presence of perinephric fluid accumulation and obstruction. One of the 5 cases was a male patient, and the other four were female, with a mean age of 53 years. He affected kidneys of the 5 cases swelled in different degrees, and one of them was found with line-like anechoic fluid. Among the 5 cases, one kidney appeared as diffusely reducing of the parenchyma echogenicity, multiple hypoechoic areas, disappearance of corticomedullary differentiation and multiple hyperecho with shadow. A round cystic anechoic lesion was found in one kidney, with internal punctate echo and peripheral fluid. Ultrasonographic finding of 1 case was extremely hypoechoic lesion on the left kidney, protruding from the outline of the kidney, with the partial renal capsule discontinuous, the less clear boundary, and a little blood flow in it. Ultrasonographic demonstration of 2 cases was mild dilatation of the collecting system with irregular wall thickening and internal hypoechogenicity, and 1 case was solid lesion with less clear boundary to the pelvic wall and a small amount of blood flow signal, the another 1 case was showed floccule without internal blood flow. Three cases were caused by chronic obstruction verified by operation, of which one was staghorn calculi, one was poorly differentiated squamous cell carcinoma in the middle part of the ureter, and one was inflammatory stricture of upper ureteral. Through analysis of the above five cases and review of related literature, we explored diagnoses and management of the patients with XGP. Xanthogranulomatous pyelonephritis (XGP) is a rare chronic variant of pyelonephritis characterized by destruction of the renal parenchyma. Combining ultrasonographic features of XGP with clinical recurrent urinary infection and chronic obstruction, XGP can be included in the differentiation. The diagnosis of XGP suspected by ultrasound can be clarified by CT, MRI, contrast-enhanced ultrasound.

[A case of sigmoid cancer occurring after uretero-sigmoid anastomosis].

Colonic neoplasia occurring in an uretero-sigmoid anastomosis is a rare case of colon cancer in the clinical practice of Russian colorectal surgeons and urologists. The article presents a case of sigmoid adenocarcinoma causing obstructive pyelonephritis.

Laparoscopic nephrectomy outside gerota fascia and en bloc ligation of the renal hilum for management of inflammatory renal diseases

ABSTRACT Objectives This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.

Laparoscopic nephrectomy outside gerota fascia and En bloc ligation of the renal hilum for management of inflammatory renal diseases.

OBJECTIVES: This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. MATERIALS AND METHODS: Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. RESULTS: Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. CONCLUSIONS: In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.

[Ureterosigmoidostomy with the formation of low pressure reservoir: history or operation of choice? 15 years of experience].

AIM: To examine the long-term outcomes of Mainz Pouch II ureterosigmoidostomy with the formation of a submucosal and extramural by Hassan (Hassan Abol-Enein) tunnels. MATERIALS AND METHODS: Mainz Pouch II ureterosigmoidostomies with the formation a submucosal tunnel (open-end technique) comprised group 1 (n=17) and with the formation of extramural ureteral implantation by Hassan - group 2 (n=15). The mean age of patients was 58+/-6.0 years, ranging from 16 to 76 years; among them there were 22 (68.8%) men and 10 (31.2%) women. Average follow-up was 14.7+/-6.0 years. All patients were continent during the daytime and at nighttime. Reservoir-ureteral reflux was detected in 2.4% (5 RU) observations and the obstruction only 1.4% (2 RU). Chronic pyelonephritis in the postoperative period was observed in 3 (9.75%) patients, whereas before surgery in 20 (62.5%) patients. The both modifications of the operation did not impair renal secretory function postoperatively in the majority of patients; in 2 of them its improvement was noted. Two patients experienced a decrease in the renal secretory function due to inadequate formation of extramural anastomosis. CONCLUSION: Mainz Pouch II and Hassan operations enable maintaining normal urination, optimize antireflux protection and are technically simple, provided the indications are carefully observed. The low incidence of complications of ureterosigmoidostomy, both in the immediate and in the long term implies that these operations may be the method of choice for continent bladder replacement in selected patients.

[Multicentric tubulopapillary carcinoma of the kidney associated with renal adenomatosis]. / Carcinome tubulopapillaire multicentrique du rein associé à une adénomatose rénale.

Tubulopapillary tumors of the kidney represent a particular group of the renal tumors. They cover a continuous spectrum of tumors ranging from the adenoma to the renal cells papillary carcinoma. The histological and immunohistochemical similarities, as well as the high recurrence of the association of these two entities suggest a continuity of the same biological process. Although rare, the association between adenoma and papillary carcinoma remains still subject to controversy and plead in favor of a narrow relation between them. We report the case of a multicentric tubulopapillary carcinoma of the kidney associated with multifocal adenomas, discovered by fortuity in a right nephrectomy at a 57-year-old patient operated for an obstructive chronic pyelonephritis.

Treatment of a case of emphysematous pyelonephritis that presented with acute abdomen and pneumoperitoneum: a case report.

BACKGROUND: Emphysematous pyelonephritis is a severe, life-threatening infection of the renal parenchyma and perinephric tissues. This condition is primarily encountered in patients with diabetes mellitus or ureteral obstruction, and is characterized by the production of intrarenal and perinephric gas. Emphysematous pyelonephritis is associated with a high degree of morbidity and a high mortality rate. CASE PRESENTATION: A 72-year-old woman with a history of diabetes mellitus, hypertension, and renal calculi was referred to our emergency department following 6 days of abdominal pain. She suddenly developed pain in the entire abdomen, and was transferred. Physical examination was a distended abdomen with hypoactive bowel sounds. The tenderness was diffuse, but was most prominent in the right upper abdominal quadrant; moreover, rebound tenderness was noted. Laboratory tests revealed a white blood cell count of 4,480/mm(3), platelet count of 17,000/mm(3), creatinine level of 1.64 mg/dl, and serum glucose level of 603 mg/dl. Abdominal computed tomography indicated the presence of free air in the intraperitoneal cavity and right perirenal space, hydronephrosis of the right kidney, and stones in the right distal ureter. After 1 hour, the vital signs changed and she appeared to become drowsy. Therefore, the patient was transferred to the operation room for laparotomy. On exploration of the abdomen, 1.5 L of pus-colored fluid was removed. Although the abdominal viscera and pelvic organs were examined, hollow viscus perforation site could not be observed. Moreover, tissue necrosis and a perforation site were identified at the superior border of the right kidney. Thus, emphysematous pyelonephritis was diagnosed and she underwent right radical nephrectomy. After the surgery, the patient was admitted to the intensive care unit for postoperative management. Follow-up CT performed after 10 days showed fluid collection and hematoma at the nephrectomy site. Hence, percutaneous drainage was performed. Another follow-up computed tomography after 3 weeks indicated that the fluid collection at the nephrectomy site had nearly disappeared. CONCLUSIONS: We believe that cases with free intraperitoneal air should promptly undergo laparotomy to identify the cause of the pneumoperitoneum. Moreover, an immediate nephrectomy may be effective for the treatment of emphysematous pyelonephritis in cases with poor prognostic factors.

Intraureteral and intravenous indocyanine green to facilitate robotic partial nephroureterectomy in a patient with complete ureteral triplication.

A patient with a complete right ureteral triplication presented with recurrent pyelonephritis and flank pain that was refractory to medical management. Evaluation showed that the atrophic upper-most renal moiety had been chronically obstructed and was associated with a dilated ureter. Intraureteral and intravenous indocyanine green (ICG) were used as real-time contrast agents intraoperatively to facilitate right robotic partial nephroureterectomy of the diseased system. Intraureteral ICG was used to accurately distinguish the pathologic ureter and associated renal pelvis from its normal counterparts. Intravenous ICG was used to assess perfusion in the right kidney and delineate the margins of diseased renal parenchyma.

[Emphysematous pyelonephritis in a non-diabetic patient with a kidney tumour]. / Emfysematisk pyelonefritis hos en patient med nyretumor og uden diabetes

Emphysematous pyelonephritis (EPN) is a potentially life-threatening infection, where gas produced by bacteria accumulates in the kidney and the surrounding tissue. Although EPN usually presents in diabetic women, it is also associated with urinary tract obstruction and kidney tumours in non-diabetic patients. We present a case of EPN in a non-diabetic patient with a known kidney tumour, successfully treated with double-J catheter, antibiotics and delayed nephrectomy.

Surgical management of early and late ureteral complications after renal transplantation: techniques and outcomes.

BACKGROUND: In this study, we present our experience with ureteral complications requiring revision surgery after renal transplantation and compare our results to a matched control population. METHODS: We performed a retrospective analysis of our database between 1997 and 2012. We divided the cases into early (<60 d) and late repairs. Kaplan-Meier and Cox proportional hazards models were used to compare graft survival between the intervention cohort and controls generated from the Scientific Registry of Transplant Recipients data set. RESULTS: Of 2671 kidney transplantations, 51 patients were identified as to having undergone 53 ureteral revision procedures; 43.4% of cases were performed within 60 d of the transplant and were all associated with urinary leaks, and 49% demonstrated ureteral stenosis. Reflux allograft pyelonephritis and ureterolithiasis were each the indication for intervention in 3.8%; 15.1% of the lesions were located at the anastomotic site, 37.7% in the distal segment, 7.5% in the middle segment, 5.7% proximal ureter, and 15.1% had a long segmental stenosis. In 18.9%, the location was not specified. Techniques used included ureterocystostomy (30.2%), ureteroureterostomy (34%), ureteropyelostomy (30.1%), pyeloileostomy (1.9%), and ureteroileostomy (3.8%). No difference in overall graft survival (HR 1.24 95% CI 0.33-4.64, p = 0.7) was detected when compared to the matched control group. CONCLUSION: Using a variety of techniques designed to re-establish effective urinary flow, we have been able to salvage a high percentage of these allografts. When performed by an experienced team, a ureteric complication does not significantly impact graft survival or function as compared to a matched control group.