Impact of Ureteral Length on Urological Complications and Patient Survival After Kidney Transplantation

Aliasgari, Majid; Dadkhah, Farid; Ghadian, Alireza; Nourbala, Mohammad Hossein

doi:10.5812/numonthly.10881

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…In a study by Ali‐Asgari et al ., the complication rate, long‐term survival and hospitalization days were not significantly different between ureters less or more than 5.5 cm. However, no information could be found on the technique of ureteral length measurement .…”

Section: Discussionmentioning

confidence: 99%

Ureteral length in live donor kidney transplantation; Does size matter?

et al. 2015

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SummaryThe aim of this study was to evaluate the role of ureteral length on urological complications. Data were retrospective collected from the INEX-trial database, a RCT to compare the intravesical to the extravesical ureteroneocystostomy. Ureteral length was measured in 198 recipients and used to divide recipients into three categories based on interquartile ranges: short (≤8.5 cm), medium (8.6-10.9 cm) and long ureters (≥11 cm). Urological complications were defined as the number of percutaneous nephrostomy placements (PCN). Fifty recipients fell into the short, 98 into the medium and 50 recipients into the long ureter category. Median follow-up was 26 (range 2-45) months. There was no significant difference in number of PCN placements between the categories. There were 9 (18%) PCN placements in the short ureter category, 21 (20%) in medium ureter category and 10 (21%) in the long ureter category, P = 0.886. Risk factor analysis for gender, arterial multiplicity and type of ureteroneocystostomy showed no differences in PCN placements between the three ureteral length categories. We conclude that ureteral length alone does not seem to influence the number of urological complications.

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Section: Discussionmentioning

confidence: 99%

Ureteral length in live donor kidney transplantation; Does size matter?

et al. 2015

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“…Two retrospective studies stated that the length of the transplanted ureter does not affect postoperative urologic complications, but these studies do not mention a ureter length exceeding 12 cm. 7,8 Most common ureter reconstruction methods are not feasible in patients with extensive medical history. An anastomosis to the native ureter can be an appropriate method.…”

Section: Discussionmentioning

confidence: 99%

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

Barański²

2019

Exp Clin Transplant

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The decision-making process for treatment of patients with end-stage renal failure, multiple failed renal transplants, and severe comorbidities can be exceedingly difficult due to the inapplicability of many common surgery methods. In this article, we report the treatment of such a patient who underwent a third renal transplant and subsequently developed a ureteral stenosis. The third kidney had been transplanted with a high abdominal position and a partially intra-and retroperitoneally placed ureter due to a bilaterally obtained iliac fossa and severe abdominal adhesions. For the severe ureteric stenosis, an alternative urinary tract reconstruction was developed by making use of the native ureter contralateral to the graft by tunneling under the sigmoid. We recommend this surgical method as a valid alternative for patients with severe ureteric graft stenosis, when treatment with stenting and common surgical ureter reconstruction methods are not feasible. Key words: Complex receptor, Constriction, End-stage renal disease, Orthotopic, Pathologic, Ureter IntroductionThe decision-making process to treat patients with end-stage renal disease and an extensive medical background, including multiple failed transplants and severe comorbidities, can be extremely difficult. In this article, we report the surgical treatment of such a patient who underwent a third renal transplant procedure and subsequently developed a ureter stenosis of the transplanted kidney.A common problem with multiple previous renal transplants is a bilaterally unavailable iliac fossa, making heterotopic transplant sometimes not suitable. In such cases, an orthotopic transplant is an alternative approach. Functional results, that is, patient and graft survival rates at 1, 10, and 20 years, are almost similar to heterotopic transplant procedures. However, the technique is challenging, and the complication rate is slightly higher than with iliac vessel heterotopic transplants. 1,2The major complications in renal transplant recipients are urologic problems in the posttransplant period, occurring with an incidence of around 3%, of which ureteric stenosis represents 25% to 30%. [3][4][5][6] The optimal surgical approach for reconstruction of such ureteric stenosis depends on the stricture's section. Because common surgical approaches or a fourth transplant are not always optimal, as for our present complicated case, an alternative approach for urinary tract reconstruction by anastomosis to the contralateral native ureter was developed. 6Case Report patient history A 22-year-old man was admitted to the hospital for a third transplant due to end-stage renal failure. His medical history included premature birth with perinatal asphyxia, spastic tetraplegia, mild mental retardation, and severe vertebral column scoliosis. He developed end-stage renal failure by perinatal asphyxia and dysplasia of the kidneys and a neuropathic bladder by tetraplegia. As a result of continuous infectious diseases, he received nephrectomy of both kidneys, without the remov...

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“…[22][23][24] Rates of urologic complications after kidney transplant range between 2.5% and 30% of all recipients. 22,23,[25][26][27] Urine leakage Urologic complications associated with the ureterovesical anastomosis after transplant may cause graft loss and mortality. Incidences of urinary leakage in different transplant centers have ranged from 0% to 8.9%, with incidences of ureteric stricture reported to range from 0.1% to 12.4%.…”

Section: Posttransplant Urologic Complicationsmentioning

confidence: 99%

“…Major urologic complications, for example leakage and stenosis, are often related to the ureteroneocystostomy. 25,28 To avoid urologic complications, clinicians at some transplant centers routinely prefer stenting as this maneuver avoids anastomotic tension, kinking, and ureteral narrowing. In our center, from 1975 to 1983, we performed ureteroneocystostomies using the modified Politano-Leadbetter technique.…”

Section: Posttransplant Urologic Complicationsmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Since the first successful organ transplant conducted between twins in 1954, kidney transplant has evolved considerably over the past 50 years. Kidney transplant plays an important role in the treatment of end-stage kidney disease to improve the quality of life and prolong the life of patients. Despite significant advances, postoperative medical and surgical complications still represent important causes of morbidity and mortality. Many problems can be avoided through prophylactic correction of abnormalities detected during the preoperative evaluation; however, it is critical that technical mishaps at all stages of the transplant process (donor nephrectomy, benchwork preparation, and implant) be prevented and that careful postoperative monitoring be carried out, including thorough examination by attending physicians. However, despite these advances, surgical complications still present serious problems in kidney transplant recipients.

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Impact of Ureteral Length on Urological Complications and Patient Survival After Kidney Transplantation

Cited by 13 publications

References 30 publications

Ureteral length in live donor kidney transplantation; Does size matter?

Ureteral length in live donor kidney transplantation; Does size matter?

High Position of the Third Renal Transplant and Alternative Urinary Tract Reconstruction in a Complicated Case

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