Minimal-invasive management of urological complications after kidney transplantation

Abstract

Kidney transplantation represents the gold standard treatment option for patients with end-stage renal disease. Improvements in surgical technique and pharmacologic treatment have continuously prolonged allograft survival in recent years. However, urological complications are frequently observed, leading to both postoperative morbidity and putative deterioration of allograft function. While open redo surgery in these patients is often accompanied by elevated surgical risk, endoscopic management of urological complications is an alternative, minimal-invasive option. In the present article, we reviewed the literature on relevant urological postoperative complications after kidney transplantation and describe preventive approaches during the pre-transplantation assessment and their management using minimal-invasive approaches.

Kidney Transplantation in the New Hospital Model in Turkey: 3 Years of Experience in Ankara City Hospital

“…UNC stenosis can be seen in 2-10% of the patients within 3 months after kidney transplantation [19]. One patient (1%) in the present study who suffered from UNC stenosis managed with long-term double J stent application 3 months after kidney transplantation.…”

Current management of symptomatic vesicoureteral reflux in pediatric kidney transplantation—A European survey among surgical transplant professionals

“…The vast majority of the reporting centers favor the use of the Lich‐Gregoir anti‐reflux extravesical approach for UCN in pediatric KTx, presumably due to lower frequency of urinary leakage, shorter operative time, and easy feasibility 4,9,19–23 . Since no consensus has been reached regarding the transplant ureteral reimplantation, it is not surprising that there are numerous other technical methods including extravesical, transvesical, and other approaches with ongoing modifications 6,22,24 …”

“…4,9,[19][20][21][22][23] Since no consensus has been reached regarding the transplant ureteral reimplantation, it is not surprising that there are numerous other technical methods including extravesical, transvesical, and other approaches with ongoing modifications. 6,22,24 The anti-reflux techniques are characterized by the formation of a submucosal tunnel but if the submucosal tunnel is applied too short, it has been suggested as a risk factor for post-transplant VUR, especially in patients with urethrovesical anomalies. 25 Interestingly, the submucosal tunnel length reported by the participating centers varies considerably, which not only reflects the lack of technical unambiguity but also leaves room for improvement.…”

“…While the body of evidence for VUR in patients without end‐stage kidney disease is well established, the available data on the long‐term impact of VUR in pediatric KTx recipients for both, native and allograft kidneys, are still conflicting 4,5 . In particular, the extent to which allograft kidney function may be adversely affected and what management strategies may improve therapeutic outcomes remains unclear 4,6–8 …”

“…4,5 In particular, the extent to which allograft kidney function may be adversely affected and what management strategies may improve therapeutic outcomes remains unclear. 4,[6][7][8] Due to the lack of robust data and consensus guidelines, there is a high variability in the management of pediatric KTx recipients with symptomatic native and allograft VUR. 8 The involvement of a multidisciplinary team with different perspectives undoubtedly contributes to heterogeneous diagnostic and therapeutic approaches.…”