Early and late urological complications corrected surgically following renal transplantation

Abstract

Summary The purpose of this study was to assess outcomes of urological complications after kidney transplantation operation. Nine‐hundred and sixty‐five patients received a kidney transplant between 2000 and 2006. In total, 58 (6.01%) developed urological complications, including urinary leakage (n = 15, 1.55%), stenosis (n = 29, 3%), vesicoureteral reflux (VUR) (n = 12, 1.2%), calculi (n = 1, 0.1%) and parenchymal fistulae (n = 1, 0.1%). Urinary leakage cases were treated by ureteroneocystostomy (UNS) via a double‐J stent and stenosis cases by UNS. Fenestration was performed in patients developing lymphoceles and unresponsive to percutaneous drainage. VUR treatment was performed by ureteroneocystostomy revision or UNS. Stent usage during ureteric reimplantation was observed to reduce urinary leakage. Surgical complication rates in renal transplantation recipients according to donor type (living versus cadaveric) and the status of stent use (with stent versus without stent) were 5.53% vs. 7.27% (P = 0.064) and 5.24% vs. 20% (P < 0.01) respectively. No recurrence, graft loss or death was seen after these interventions. Comparison of recipients with and without urological complication showed that there was no difference between groups (P > 0.05) with respect to last creatinine level. No graft or patient loss was associated with urological complications. Urological complications that can be surgically corrected should be aggressively treated by experienced surgeons and graft loss avoided.

Ureterocalicostomy to Salvage a Renal Allograft with Pyeloureteral Necrosis

“…For distal ureteral necrosis, revision of the ureteroneocystotomy is advocated, as it obviates the need for dissection of the transplanted kidney itself. 1,6 In the setting of insufficient ureteral length, bladder mobilization with either a psoas hitch or Boari fl ap of the bladder may be utilized to reduce the distance from bladder to ureter. 6 When longer gaps need to be traversed, however, perhaps the best-suited tissue for the reconstruction of a necrotic allograft ureter is the recipient's native ipsilateral ureter.…”

“…U rinary complications have been noted to occur in approximately 6% of renal transplantations in recent series. 1,2 Ureteral necrosis, in particular, complicates 2%-3% of these procedures. 3,4 An extreme variant of this phenomenon, necrosis of the entire allograft ureter and renal pelvis, is a particularly unusual but potentially devastating complication of renal transplantation that can result in signifi cant morbidity-including graft loss-as well as mortality.…”

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“…It is essential to eliminate first an obstruction resulting from a blocked catheter, which can lead to perforation or release of anastomosis. 9,10 The site of the urinary leak is often at the ureteral anastomosis and rarely due to a caliceal leak or to bladder perforation. The cause of ureteral leak can be either related to technical failure (ureteric kinking or suture dehiscence) or to ureteric ischemia.…”

“…An anastomotic pyeloureteral leak can be related to a malpositioned double J stent that may have perforated through the pelvis of the transplanted kidney. 4,10 Bladder leak can be due to bladder wall dehiscence. A urinary leak can be also secondary to bladder retention as a result of blocked transurethral catheter.…”

Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report

“…The most common causes of obstructive uropathy of the graft are classified as renal and extra-renal. Among early renal complications are perirenal fluid collections (lymphocele, hematoma, urinoma), and in the later stage stricture and vescico-ureteral reflux [3]. Among the extra-renal causes there are benign prostatic hypertrophy and ureteral stenosis [2].…”