The SPBG was then inserted through the Amplatz sheath under fluoroscopy such that a radiopaque mark sits between the calyx and renal parenchyma (Fig.
A decision was then made to attempt bilateral SPBG insertion.
Given the option of ureterolysis or SPBG insertion, the patient chose the latter.
The stone was removed via flexible ureteroscopy and basket extraction through the SPBG, and the serum creatinine returned to baseline levels.
She was deemed not suitable for ureterolysis, and nephrostomy tubes were inserted in preparation for SPBG graft placement (Fig.
We describe for the first time the bilateral insertion of SPBG as a treatment for ureteral obstruction in RPF.
In a previous study involving renal transplant recipients, 2 out of 8 patients developed distal dislodgement following SPBG insertion with successful reinsertion.[sup.15] As all 3 patients in the present study received bilateral grafts simultaneously, the risks of such complications may have been elevated.
We present 3 cases of simultaneous bilateral SPBG insertion as a treatment for urinary obstruction in refractory cases of RPF.
Table 1.: Markers of renal function prior to and at last follow-up after bilateral SPBG treatment [Table omitted]
Recurrent infections are another limitation of the SPBGs. After a mean follow-up of 18.3 months, 1 patient developed 2 episodes of pyelonephritis requiring long-term prophylactic antibiotics.