Stable Outcome After Living Donor Kidney Transplantation Using External Urinary Fistula for a Kidney Graft With Duplicate Ureters: A Case Report

Background. A kidney with a duplicate ureter used as a graft in kidney transplantation poses a concern about the risk of suture failure at the ureterovesical anastomosis. Many institutions attempted to reduce complications by placing internal fistula stents, such as Double J Stents, at the anastomotic site. We actively place external fistula catheters in these high-risk cases at our hospital. Case presentation. A 65-year-old male patient developed chronic renal failure due to diabetic nephropathy and underwent a preemptive living kidney transplant with his wife as the donor, but the graft contained two duplicate ureters. We established a method to prevent serious complications by inserting an external urinary fistula catheter during ureterovesical anastomosis. The anastomosis and ureter were directly assessed by injecting a contrast medium postoperatively for external urinary fistulas. Distinguishing and measuring the amount of urine from each ureter becomes possible. Additionally, it was useful for urinary training postoperatively. Noteworthily, the catheter can be removed simply by pulling it out and does not require a cystoscope. The patient achieved an uneventful postoperative course and was discharged from the hospital. Conclusions. Inserting an external urinary fistula catheter demonstrated many advantages and will be used effectively in the future.