Caliceal Urinary Fistula in Renal Allotransplantation

Poppel, H. Van; Arango, O.; Gil-Vernet, J.M.

doi:10.1159/000472515

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…The treatment of the caliceal fistula consists of the excision of the necrotic kidney tissues and closure of the kidney calyx. According to some authors, the surgical intervention should be done immediately after the diagnosis of the caliceal fistula is established 9 . However, a conservative treatment by percuteneous nephrostomy may be successful in some cases.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent caliceal fistulas were also described 10 . In order to decrease the risk of repeated leakage of the sutured calyx, the line of sutures can be additionally covered with parietal peritoneum, omentum maius or lyophilized human dura mater, finally sealed with fibrin or cyanoacrylate glue 1,9 , 10 . In the presented case, excellent result was achieved by simple suture of kidney calyx accompanied by a double pigtail ureteric stent insertion.…”

Section: Discussionmentioning

confidence: 99%

“…According to some authors, the surgical intervention should be done immediately after the diagnosis of the caliceal fistula is established. 9 However, a conservative treatment by percuteneous nephrostomy may be successful in some cases. Ngatochu et al reported a case where a caliceal fistula was healed after 21 days of nephrostomy.…”

Section: Discussionmentioning

confidence: 99%

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Late caliceal fistula after kidney transplantation

Król¹,

Ziaja²,

Kolonko³

et al. 2006

Int J of Urology

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Caliceal fistula is a rare urological complication that can occur usually shortly after kidney transplantation (KTx). The occlusion of the renal accessory artery with subsequent necrosis of the kidney pole is the most common cause of the fistula development. We report a case of a 57-year-old man with reconstruction of two accessory renal arteries by anastomosis to the side of the main artery during graft placement complicated by late caliceal fistula, managed surgically. Directly after KTx good kidney graft function (serum creatinine concentration 151 µmol/L) was observed. The patient noticed protuberance and pain in the kidney graft area 5 months later. Diagnostic imaging revealed moderate urostasis and liquid collection in the region of the lower graft pole. Administration of a contrast medium through the inserted drain visualized a fistula of a lower renal calyx and ureteric stenosis. Percutaneous drainage was applied with subsequent stop of diuresis through the urethral catheter. During the surgery, the resection of a lower kidney graft pole necrosis was performed, with the closure of caliceal fistula. Simultaneously double pigtail ureteric stent was inserted. After the next two months the pigtail catheter was removed, and neither urostasis in the kidney graft nor liquid collection in the perigraft area were observed. The exceptionality of the case is the late caliceal fistula occurrence. We may only speculate, why it happened 5 months after KTx. The thrombosis of stenosed accessory artery is the most probable cause.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Late caliceal fistula after kidney transplantation

Król¹,

Ziaja²,

Kolonko³

et al. 2006

Int J of Urology

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“…. Случаи нефрэктомии трансплантата по поводу длительно не заживающей фистулы чашки также описаны в литературе [7].…”

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“…Однако в данном случае мы столкнулись с более редким видом МС -чашечковым свищом. К возникновению подобного осложнения приводит фокальный некроз чашки и паренхимы почки, который является следствием ишемии паренхимы почки[7]. c. lagergren et al (1962) провели комбинированное микроангиографическое и гистологическое исследования почек с папиллярным некрозом.…”

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Retrograde endoscopic-assisted percutaneous treatment of transplanted kidney calyceal fistula

2022

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Introduction. Calyceal fistula is a rare complication of a renal transplantation. This complication can lead to postoperative graft failure. The treatment approaches range from a partial nephrectomy to a routine nephrostomy.Objective. To present the successful application of the retrograde endoscopic-assisted percutaneous treatment of transplanted kidney calyceal fistula.Clinical case. A patient after kidney allotransplantation is under our care. Control postoperative ultrasound examination revealed a pararenal fluid mass in the left iliac region. Its percutaneous drainage was performed. Biochemical analysis revealed high levels of creatinine and urea in the drainage discharge. Despite ureteral stent and urethral catheter drainage, about 500 to 600 ml of urine per day was excreted by the drainage. Percutaneous puncture nephrostomy could not be performed due to the absence of dilatation of the renal cavity system. In the lithotomic position, the damaged calyx was identified by performing flexible ureteropyeloscopy. Then we percutaneously targeted the injured calyx and the distal end of the ureteroscope inserted transurethrally, so that the needle tip appeared in the paranephral cavity opposite the injured calyx. Under the control of a flexible ureteroscope the needle was inserted into the kidney pelvis, a nephrostomy tube 12 Ch was placed along the string. The discharge through the drain stopped within a week and it was removed. Follow-up examination nine weeks after surgery revealed that the patient had no complaints and renal ultrasound showed no features, so the nephrostomy tube was removed.Conclusion. The described method is the minimally invasive, affordable, and efficient method for the treatment of transplanted kidney calyceal fistula.

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Caliceal fistula in kidney transplantation

Ngatchou¹,

Hoang²,

Firket³

et al. 2002

Transplant International

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Caliceal fistula is a rare complication of renal transplantation, which often raises some diagnostic problems. We report the case of a patient in which this complication occurred and in whom the diagnosis could be clearly demonstrated by using magnetic resonance imaging (MRI). On the T1-weighted images, a perirenal collection was depicted by a low signal intensity. On T2-weighted images, the collection appeared with a high signal intensity, and a linear hyperintensity was observed on the internal graft's labium at the level of the inferior pole corresponding to a caliceal fistula arising from the lower pole of the graft. In this setting, the use of MRI is compared with the other diagnostic techniques (sonography, CT scan, nephrogram, scintigraphy). MRI constitutes a progress in imaging of the renal graft by its high definition and the lack of nephrotoxicity. Its place remains, however, to be more precisely defined in the evaluation of a renal graft's complications.

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Caliceal Urinary Fistula in Renal Allotransplantation

Cited by 5 publications

References 16 publications

Late caliceal fistula after kidney transplantation

Late caliceal fistula after kidney transplantation

Retrograde endoscopic-assisted percutaneous treatment of transplanted kidney calyceal fistula

Caliceal fistula in kidney transplantation

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