Intraoperative vascular localization to facilitate endopyelotomy after renal transplantation

Pelviureteric junction (PUJ) obstruction after renal transplantation is uncommon. Surgical correction can be technically challenging due to dense perinephric adhesions and variable hilar vascular anatomy. Endopyelotomy is well established in the treatment of PUJ obstruction in native kidneys.

The present paper reports the first experience of antegrade visual cold-knife endopyelotmy performed in a renal allograft. In orientating the incision at the PUJ, preoperative imaging was supplemented by intrarenal Doppler ultrasound, using a probe designed for transoesophageal cardiac monitoring. To the authors' knowledge this approach has not previously been reported.

Renal vascular relationships were readily indentified by identifying arterial and venous waveforms.

For this uncommon procedure the use of intrarenal Doppler ultrasound provides greater security in avoiding inadvertent vascular injury.