corynebacterium urealyticum , a gram - positive bacillus , has been identified as the most frequent causative pathogen .
urinary stasis is highly likely to contribute to stone formation , because large - scale spontaneous precipitation of crystals occurs when a critical concentration ( e.g. , supersaturation ) is exceeded .
failed treatment of encrusted pyelitis in a transplanted kidney can cause graft failure or nephrectomy . to overcome urinary stasis with encrusted pyelitis in a transplanted kidney , we report surgical treatment by ileo - pelvic anastomosis without nephrectomy .
in addition , in this case , augmentation cystoplasty was performed to strengthen the atrophied bladder following tuberculosis .
a 51-year - old female patient received a kidney from her sister after a double nephrectomy owing to renal tuberculosis 12 years previously . at that time , the transplanted ureter was anastomosed to the ileum in the left lower abdomen with an ileal conduit on the opposite side .
the patient experienced no problems for 12 years . at a routine checkup , she complained of abdominal pain , gross hematuria , and increased debris in the ileal conduit .
her serum creatinine was elevated to 1.7 mg / dl ( normal , 0.6 to 1.1 mg / dl ) , and her transplanted kidney developed hydronephrosis with calcified debris observed by sonography ( fig .
neither hydronephrosis nor calcified debris had been observed 6 months before in a routine outpatient checkup .
abdominopelvic computed tomography revealed hydronephrosis with encrusted pyelitis and ureteritis in the transplanted kidney ( fig .
a cystogram showed that the bladder was not refluxed but had a small capacity ( 50 ml ) .
after 3 weeks , we operated to anastomose the transplanted renal pelvis to one end of the ileal conduit , performing augmentation cystoplasty with new ileum and to anastomosis the other end of the remnant ileum with the augmented bladder .
augmentation cystoplasty is a reconstructive technique for creating a compliant , large - capacity urinary storage unit to protect the upper urinary tract .
the operation was performed via a midline incision . because it was difficult to approach the major calices of the transplanted kidney in the left pelvic rim
, we anastomosed one end of the ileal conduit to the pelvis of the transplanted kidney in an end - to - end fashion .
the ileal conduit was lengthened by 30 cm to extend from the pelvis to the augmented bladder chimney .
after exposure of the urinary bladder , a transverse wide v - shaped cystostomy incision was created , with the apex approaching the anterior bladder neck and the base extending posteriorly past the midcoronal plane of the bladder dome .
a 20 cm segment of new ileum at least 15 cm proximal to the ileocecal junction was used for ileocystoplasty . for the small bowel ,
a v - shaped plate was created by a side - to - side anastomosis with 2 - 0 vicryl .
a circumferential , continuous , full - thickness , single layer anastomosis of the bowel to the bladder was started posteriorly by using 2 - 0 braided absorbable sutures .
the other end of the ileal conduit was anastomosed through small separate ileotomies ( 1.5 cm length ) in the limb of the augmentation cystoplasty .
a follow - up cystogram showed increased bladder capacity to approximately 300 ml with well - preserved end - to - end anastomosis of the ileo - pelvic portion with the other end of one chimney of augmentation cystoplasty with the elongated ileal conduit ( figs . 3 , 4 ) .
the most common causative agent in the formation of infection stones is a urease - positive urinary tract infection .
less invasive methods are preferable to preserve the connection between the renal pelvis and the upper ureter .
ileo - pelvic anastomosis must be adjusted for patients with infection stones in the upper urinary tract after renal transplantation . an alternative way to prevent these infection stones
is to ensure a wider pathway through a ureter that has been narrowed in places by these stones . according to a report on the incidence of urolithiasis in cystectomy patients , 5 of 78 patients who had undergone diversion with an intestinal conduit developed urolithiasis , all in the upper tract .
in contrast , 4 of 78 patients who had received a diversion had a renal stone at the time of presentation
. refluxing urine may contribute to an increased risk of stone formation after urinary diversion , whereas pouch stasis may contribute to stone formation in the diversion group .
a case of failed treatment of encrustation in a kidney transplant recipient was reported and graft removal was performed after 6 months of failed management owing to intractable febrile urinary tract infections that became life threatening .
they excised renal parenchyma from the caudal portion of the inferior calyx , which was then anastomosed to the ileostomy . in their case ,
bladder capacity was within the normal limit ; thus , augmentation cystoplasty was not indicated . in conclusion , if urinary tract infection is controlled , we suggest that ileo - pelvic anastomosis   combined with augmentation cystoplasty   is an alternative for the treatment of encrusted pyelitis with atrophied bladder . in our patient , we performed ileo - pelvic anastomosis to prevent urinary stasis by elongating the ileal conduit .
in addition , the augmentation cystoplasty technique is useful for increasing bladder capacity that has been diminished by renal tuberculosis ( fig .
 infection stones are more likely to form after urinary diversion as the result of urinary stasis . to prevent urinary stasis due to encrusted pyelitis in a transplanted kidney 
 , we describe an alternative a surgical treatment : ileo - pelvic anastomosis . in our patient with a transplanted kidney , 
 the ileal conduit had previously been anastomosed end - to - side owing to renal tuberculosis with an atrophied bladder ; the transplanted ureter was anastomosed to the ileum in the left lower abdomen with an ileal conduit on the opposite side . 
 routine check - up revealed hydronephrosis with infected pyelitis and ureteritis in the transplanted kidney . 
 we performed ileo - pelvic end - to - end anastomosis to prevent urinary stasis by lengthening the ileal conduit and performed augmentation cystoplasty to support the atrophied bladder following tuberculosis . 
 we suggest that this approach may be useful in similar cases . 