Delhi doctors conduct ureter reconstructive surgery on youth

Doctors at a city hospital gave a new lease of life to an 18-year-old youth who was suffering from leaking kidneys by carrying out a special reconstructive surgery of the ureter.
Arjun, son of a railway employee, had undergone two kidney transplants in the last 5 years. However, a leaking kidney - urine leakage from the ureter which connects kidney to the urinary bladder - left him troubled.
"Arjun came to us after two failed kidney transplants and a hurriedly done stenting. After first right kidney transplant in 2012, Arjun developed graft rejection with renal failure and was put on dialysis. Second transplant of left kidney took place in 2014, which also got rejected resulting in blood collection around the kidneys, acute pain and swelling," said H S Bhatyal, Advisor and Senior Consultant, Urology and Renal Transplantation, BLK Super Speciality Hospital.

Immediately after transplant, Arjun developed abdominal expansion for which an emergency surgery was performed and he was found to have urine leakage from the ureter. Repair of the leaking area was done, but after one week, he again developed gross abdominal swelling with urine leakage, Bhatyal said.
He was taken for surgery again where the transplanted kidney ureter was found to be necrosed (causing cell damage) and non-viable so his ureter was joined to the transplanted kidney and he was told to be on tube for rest of the life.
The drainage tube was found to be blocked with swelling in transplanted kidney and there was large collection around it. So the tube was removed and reinserted under ultrasound guidance to drain the collection, he said, adding, about one litre of blood-mixed urine was drained out.

Arjun then reached BLK Super Speciality with swollen abdomen. During clinical evaluation, it was found that water was getting collected in his kidneys and not going to the bladder. Sides of the kidneys were also filled with blood.

"Firstly, under ultrasound guidance tube was inserted into the kidney to drain out urine through a procedure called Percutaneous Nephrostomy (PCN). After that, we had to wait and monitor the kidney function till cooling off period of three months. Under this, tissues were allowed to heal," he said.
The team then planned a challenging reconstructive procedure of ureter called Boari Flap Reconstruction which, under normal conditions, is done by using parts of large and small intestine.

Bhatyal and his team managed reconstruction of second transplanted kidney by making a long tube of 10 cm from urinary bladder and joining it directly to the kidney.
"A flap was raised from the bladder to construct a tube and take it up to the other kidney and a 12 cm tube was created to connect the kidney. This is called Boari Flap Reconstruction and it was done in August last year and Arjun was again kept under observation for six months," he said.
Arjun has recovered and is experiencing no urine leak six months after reconstruction. He is free of external tube with functioning transplanted kidneys.