# Rectus sheath patch. A novel surgical technique in the repair of isolated renal pelvis necrosis in a transplanted kidney. A case report

## TL;DR

A new surgical technique using a rectus sheath patch successfully repaired a urine leak in a transplanted kidney, potentially saving the graft.

## Contribution

A novel surgical technique using an avascular rectus sheath patch for repairing isolated renal pelvis necrosis in transplanted kidneys.

## Key findings

- A 70-year-old patient with a urine leak after kidney transplantation was successfully treated using a rectus sheath patch.
- Post-operative imaging confirmed no ongoing urine leak six weeks after the procedure.
- The technique offers simplicity and low donor site morbidity but carries risks like patch failure or hernia.

## Abstract

Focal necrosis of the renal pelvis in a transplanted kidney is a rare but often morbid complication that may lead to graft loss. Given the scarcity of donor organs, all attempts are made to preserve the graft. Currently there is no standard surgical technique for reconstruction or repair of isolated renal pelvic necrosis.

A 70-year-old male with end stage kidney disease underwent renal transplantation. The patient developed a day-three post-operative urine leak. During surgical exploration, a focal area of pelvic necrosis was observed without evidence of proximal or distal ureteric involvement. Given the excellent function of the renal allograft, a novel surgical technique was successfully used to repair the necrotic defect. Reconstruction of the renal pelvis was performed using an avascular rectus sheath patch. The patch was secured over the open pelvis following necrotic tissue debridement. The patient made a successful recovery with complete resolution of urine leak. A 6-week post-operative retrograde pyelogram confirmed no ongoing urine leak.

To restore anatomy, the pelvic defect was patched with avascular rectus sheath fascia. Advantages of this reconstructive method were technique simplicity and low donor site morbidity. Potential complications included patch failure with ongoing urine leak, ventral wall hernia through the fascial donor site and stenosis of the ureteropelvic junction.

This case highlights the successful surgical management of a renal pelvis urine leak patched with rectus sheath fascia. This technique could be considered as a graft saving procedure in similar cases where the alternative is transplant nephrectomy.

•Successful repair of an isolated urine leak using a rectus sheath patch•Urine leak following renal transplantation•A novel surgical technique in the repair of an isolated renal pelvis urine leak

Successful repair of an isolated urine leak using a rectus sheath patch

Urine leak following renal transplantation

A novel surgical technique in the repair of an isolated renal pelvis urine leak