Perinephric Abscess With Ureteric Obstruction After Renal Transplantation

Zazgórnik, J; Schmidt, Paul; Kotzaurek, R; Kopsa, H

doi:10.1016/s0140-6736(73)90183-9

Cited by 6 publications

(3 citation statements)

References 2 publications

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“…Ureteral complications are one of the most frequent issues encountered after kidney transplantation, in 2-26% of reported series [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. Ureteroneocystostomy is used routinely [13,14,15,16,17,24,25,30], ureteroureterostomy [19,20,22,34] and pyeloureterostomy [19] less frequently, and each technique has its pearls and pitfalls [29].…”

Section: Resultsmentioning

confidence: 99%

“…Most ureteral complications occur early in the postoperative course, and urinary fistula represents the most frequent one. In the late postoperative period, other concerns will be considered, including stenosis [23,29,30], cutaneous urinary fistulas [21,23,27,28,30], ureterolithiasis [26], periureteral abscess and fibrosis [18,33]. Imaging modalities will help to rule out these complications, in addition to a high index of suspicion.…”

Section: Resultsmentioning

confidence: 99%

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Pseudorejection and True Rejection after Kidney Transplantation: Classification and Clinical Significance

Khater

Khauli²

2012

Urol Int

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Objectives: Multiple factors may result in an elevation in serum creatinine level after kidney transplantation, mimicking rejection. It is crucial to differentiate between a true rejection and other conditions inducing a ‘pseudorejection', in order to avoid overtreatment, or worse, mistreatment. Our goal was to review and classify true rejections and pseudorejections and their clinical significance. Material and Methods: This was a retrospective review of articles published in the USA and Europe, from 1976 to the present. The sites from which information was retrieved included PubMed, Clinical Imaging, Histopathology, Archives of Surgery, JACS, the American Urological Association, Medline and Springer Link. The importance of the resistive index will also be emphasized. Results: We reviewed 61 articles regarding the causes of renal graft dysfunction, which may be classified into true rejections and pseudorejections, the latter including the following 6 factors: hyperglycemia, ureteral obstruction, lymphocele, arterial stenosis, infection and recurrence of primary pathology. Conclusions: ‘Pseudorejection' has been described only once, for the first time in 1976 in the USA, and there have been no other reports since then. Multiple factors, mainly hyperglycemia, may induce a pseudorejection, presenting with an elevation of serum creatinine level and leading the clinician to an erroneous diagnosis of true rejection initially, resulting in inappropriate management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pseudorejection and True Rejection after Kidney Transplantation: Classification and Clinical Significance

Khater

Khauli²

2012

Urol Int

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“…(g) Abscess Formation. Fletcher and Lecky (1969) and Zazgornik et al (1973) described cases in which a perinephric abscess appeared to cause kinking of the ureter. Drainage of the abscess resulted in relief of the obstruction.…”

Section: Early Fall Of In Established Renal Functionmentioning

confidence: 99%

The Surgery and Problems of the Ureter in Human Renal Transplantation

Bewick

Collins

Saxton

et al. 1974

British Journal of Urology

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There is now extensive experimental and clinical experience of renal allotransplantation, but there is still an appreciable incidence of complications referable to disorders of urinary drainage.The main reported series since 1966 (Table I) shows that the incidence of such urological problems is between 10 and 20% with a significant mortality. This paper reviews our management of 200 consecutive transplants and describes details of techniques used and developed in the light of our experiences, with particular reference to the problems which arise in relation to the ureter. Primary Surgical TechniquesPrimary urinary drainage was achieved in I96 cases using the technique of uretero-cystostomy. A sub-mucous tunnel was created after the technique of Politano and Leadbetter (1958) and the ureter anastomosed to the mucosa of the bladder after the nipple technique of Paquin (1959) and Starzl et al. (1964).Only a few points need mentioning about these techniques. Paccione (1965) pointed out that the normal ureter, when divided, immediately starts to swell owing to oedema of the adventitia. In the case of the renal allograft this swelling does not start until the kidney is re-vascularised, and the ureter will swell, not only because it has been divided, but also because there is a reactive hyperaemia due to the ischaemia and, possibly, some mild early allograft reaction. Thus the incision through the bladder muscle layer and the sub-mucosal tunnel must be large. We have not attempted to place the ureteric orifice in any particular site in the bladder. We believe that a site convenient for the surgeon is more important than a correct anatomical situation. We have been careful not to disturb the patient's own ureteric orifices. The ureteric epithelium and the vesical mucosa are united by multiple interrupted 4/0 chromic catgut sutures. The ureteric vasculature is not formally ligated, but care is taken to ensure that the interrupted sutures occlude the vessel at the end of the spatulated ureter.At no time have we found the production of a sub-mucous tunnel difficult and have not found it necessary to use the technique described by Kenefick et al. (1972). Only occasionally does haemorrhage within the tunnel occur and we have found that this usually subsides satisfactorily if a little pressure is applied before the ureter is passed along it. Only 2 patients have presented early after transplantation with ureteric obstruction which could possibly have been due to the presence of a sub-mucous tunnel haematoma. A ureteric splint was used in only 3 cases where there was some technical difficulty in performing the ureter-to-mucosa anastomosis. These splints were removed uneventfully on the first postoperative day.The anterior cystostomy is closed with 2 layers of continuous 2/0 chromic catgut and an outer layer of interrupted catgut. After closure, the intramuscular part of the tunnel is again inspected from the external aspect of the bladder and ascertained to be adequate. Initially, drains to the retropubic space and/or the ret...

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