Management of extensively destroyed ureter: special reference to renal autotransplantation

Renal autotransplantation has been attempted 6 times in 4 patients for the correction of extensive ureteral disease. Indications in these patients include trauma secondary to ureterolithotomy and spinal fusion, and failed supravesical diversionary procedures. Included in our report is the first case of autotransplantation associated with ureterosigmoidostomy. Renal autotransplantation is an effective method to restore or preserve renal function in patients with extensive ureteral damage or disease. However, the procedure should not be considered in poor risk patients with good contralateral renal function or in patients in whom standard reparative procedures are possible. The hazard is real of vascular spasm, poor perfusion and ultimate autograft failure in kidneys with advanced chronic pyelonephritis and/or inflammation involving the renal pedicle. Autotransplantation should be considered only as a last resort in such patients.