ÜRETER DUBPLİKASYONLU GREFT BÖBREKLERDE NAKİL TECRÜBEMİZ

Year 2019, Volume: 26 Issue: 2, 195 - 200, 01.06.2019

Yucel Yuksel

https://doi.org/10.17343/sdutfd.499151

Abstract

ÜRETER DUPLİKASYONU OLAN GREFT BÖBREKLERDE BÖBREK NAKLİ
TECRÜBEMİZ

Amaç:
Kronik
böbrek yetmezliğininin en etkili, tedavisi böbrek naklidir . Böbrek nakli
sonrası ürolojik komplikasyonlar, 
morbiditeyi arttırmaktadır . Üreter duplikasyonu       ( ÜD), üst üriner sistemin en sık
görülen anomalisidir . ÜD prevalansı, % 0.6-% 1, arasında değişmektedir. ÜD’lu
böbrek greftlerinde yapılacak üreter mesane anastomuzunun nasıl yapılacağı
ilgili görüş birliği yoktur. Bu çalışmamızda, kliniğimizde yapılmış olan ÜD'lu renal
transplantasyon tecrübelerimizi ve sonuçlarımızı paylaşmayı amaçladık.

Gereç
ve Yöntem: Ocak
2013-  Aralık 2017 tarihleri arasında
Antalya Medicalpark Organ Nakli Bölümünde ÜD’li greft böbrek ile  böbrek nakli yapılan hastaların sonuçları
retrospektif olarak analiz edildi. Hastaların yaş, cinsiyet, donör türü, donör
yaşı, donör ameliyatının tipi, böbrek nakli sonrası takip süresi, ortalama
ameliyat süresi, böbrek nakliöncesi dializ türleri, böbrek nakli sayısı, böbrek
nakli sonrası üriner komplikasyonlara, kreatinin düzeyi, greft sağ kalımı ile
birlikte  hasta sağ kalımına
değerlendirildi.

Bulgular:
Merkezimizde
ocak 2013- aralık 2017 tarihleri arasında 2039 böbrek nakli yapıldı. Olguların
28 (% 0,1)’inde ÜD saptandı. Hastaların ortalama yaşı 38 .07 ±14.7 (range
8-60). Erkek kadın oranı 1.1 di. Böbrek alıcılarının 15’i erkek 13'ü kadındı,
böbrek donörlerinin  22'si canlı 6'sı
kadavraydı. Donörlerde (kadın, erkek )oranı 3 saptandı. Ortalama donör yaşı
48.6 ± 15.5 (14-81) di. 13 hasta preemptif, 14 hasta hemodializ, 1 hasta
da  periton dializi yapmakta idi.
Ortalama ameliyat süresi 80.6±13.4 dakika (65-109). Bir hastada böbrek nakli
sonrası 2. ayda idrar kaçağı oluştu (%3.5). Diğer hastalarda üriner
komplikasyon saptanmadı.

Sonuç: Böbrek
naklinde  greft böbreklerde ÜD böbrek
nakli için engel kabul edilmemelidir, tecrübelerimize göre ÜD olan greft
böbreklerde tek ostiumlu Lich Gregoir Üreteroneosistostomi,
yöntemi, 2 adet DJS kullanılarak yapılması, diğer  yöntemlere göre daha güvenlidir.

Anahtar Kelimeler:
Böbrek Transplantasyonu, Üreter dublikasyonu,
Üreteroneosistostomi, Komplikasyon

 

OUR EXPERİNCE WİTH
KİDNEY TRANSPLANTAİON IN KIDNEYS WİTH URETER DUPLİCATİON

Purpose: The most effective treatment of chronic renal failure is
kidney transplantation. Urological complications after kidney transplantation
increase morbidity. Ureter duplication (UD) is the most common anomaly of the
upper urinary tract. . There is no consensus on how to perform ureter bladder
anastomosis in kidney grafts with double ureters. In this study, we aimed to
share our experience and results of renal transplantation with grafts having UD
anomaly performed in our clinic.
Methods: Between January 2013 and
December 2017, the results of transplantations at Antalya Medical Park
Transplantation Center with kidney grafts which had ureteral duplication were
analyzed retrospectively . Age, sex, donor type, age of donor, type of donor
operation, duration of renal transplantation, mean operation time, pre-renal
dialysis types, number of kidney transplants, urinary complications after
kidney transplantation, creatinine level, graft surviv and patient survival
were evaluated
Results: Between January 2013 and
December 2017, 2039 kidney transplants were performed in our transplantation
center. UD was detected in 28 cases (0.1%). The mean age of donors was 48.6 ±
15.5 (14-81).  The mean operative time
was 80.6 ± 13.4 minutes (65-109). Urinary leakage occurred in one patient
(3.5%) within the 2 months after renal transplantation .There were no urinary
complications in other patients
Conclusion:In renal transplantation, the
graft with ureteral duplication should not be considered as an obstacle for
renal transplantation .We experienced that Lich Gregoir Ureteroneocystostomy  method with single-ostium by using 2 Double –J
stents in the kidney grafts with UD is safer than other method.

Keywords: Kidney
transplantion, Ureter duplication Ureteroneocystostomy, Complications

 

 

Keywords

Böbrek Transplantasyonu, Üreter Duplikasyonu, Üretereneosistostomi, Komplikasyon

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