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2018, Number 2

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Rev Mex Traspl 2018; 7 (2)

First renal transplant with urinary diversion (ileal conduit) performed in the Yucatan Peninsula

Rendón-Dosal HD, Villalobos-Gollás M, López-Rosales FJ, Canul-Moreno SMÁ, Becerra-Peña LA, Maldonado-Ortiz SY, Díaz-Yupit, T

Language: Spanish
References: 17
Page: 65-70
PDF size: 300.18 Kb.


ABSTRACT

Neurological dysfunction of the lower urinary tract may be the result of various diseases and episodes that affect the nervous systems that control them. Yucatan is one of the six states with the highest prevalence in the country with reports of neural tube closure defects. Congenital neural tube closure defects associated with lower urinary tract dysfunction may cause long-term chronic renal failure, with renal transplantation being the effective therapeutic option. There are multiple techniques for the practice of lower urinary tract diversions, mostly using segments of the gastrointestinal tract such as the ileal conduit with Bricker technique, which is always recommended prior to transplantation. Presentation of the case: A 31-year-old male patient from Yucatan with a diagnosis of sacral myelomeningocele at eight years of age. Chronic renal disease in 2011, secondary to neurogenic bladder by myelomeningocele. Renal function replacement therapy with haemodialysis from 2014. He underwent a transplant protocol with his sister as a donor. In January 2017, the ileal conduit 25 cm proximal to the ileocecal valve is made by laparoscopy, with a length of 12 cm, externalised towards the right flank and with a protrusion of 3 cm. Renal transplant in June 2017 with thymoglobulin-based induction at 1 mg/kg weight for four days. Laparoscopic left nephrectomy was performed in the donor; left kidney was obtained with two renal arteries with bench surgery and ischemia time of 70 minutes. Extraperitoneal extraperitoneal ureteroileal anastomosis was performed with stent placement. The patient evolves satisfactorily, being discharged 10 days after the transplant with immunosuppressive therapy based on tacrolimus, mycophenolic acid and prednisone. Seven-month follow-up, during which he had two episodes of lower tract urinary tract infection, with no impact on function and with a last creatinine figure of 1.28 mg/dL.


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