Surgical management of early and late ureteral complications after renal transplantation: techniques and outcomes

Abstract

Using a variety of techniques designed to re-establish effective urinary flow, we have been able to salvage a high percentage of these allografts. When performed by an experienced team, a ureteric complication does not significantly impact graft survival or function as compared to a matched control group.

Urologic Considerations and Complications in Kidney Transplant Recipients

“…The latter type of urine leak can increase the risk of transplant ureteral stricture formation and often requires surgical reconstruction. 38 Factors that may increase the risk for distal ureteral ischemia include failure to preserve the distal periureteral fatty tissue during preparation of the native ureter during donor nephrectomy, variations in vascular anatomy, and allograft rejection. 39 Transplant kidney ureteral obstruction can occur both early and late.…”

“…[40][41][42][43] Manipulation of the stent can be difficult during the immediate postoperative period, so definitive management is usually performed with interventional radiology obtaining antegrade ureteral access using a percutaneous approach. 38 If narrowing or stricture is documented on antegrade nephrostoureterogram, antegrade transplant ureteral stenting and balloon dilation may be required. 38 Late urologic complications include retained ureteral stent, ureteral or ureterovesical stricture, VUR resulting in pyelonephritis of the graft, and nephrolithiasis.…”

“…38 If narrowing or stricture is documented on antegrade nephrostoureterogram, antegrade transplant ureteral stenting and balloon dilation may be required. 38 Late urologic complications include retained ureteral stent, ureteral or ureterovesical stricture, VUR resulting in pyelonephritis of the graft, and nephrolithiasis.…”

“…46 First-line options for treatment of ureteral or ureterovesical stricture include retrograde placement of a ureteral stent, with or without balloon dilation, laser incision of a ureteral stricture, or percutaneous nephrostomy with antegrade access. 38,47,48 Open ureteral reimplant or native ureteropyelostomy are definitive surgical options when endourological options fail. 38 Berli and colleagues 38 showed that management of ureteral complications posttransplant using ureteroneocystostomy, ureteroureterostomy, ureteropyelostomy, pyeloileostomy, and ureteroileostomy resulted in a high percentage of graft salvage, and compared with a matched control group, these potentially devastating complications do not worsen graft survival when performed by an experienced team.…”

“…38,47,48 Open ureteral reimplant or native ureteropyelostomy are definitive surgical options when endourological options fail. 38 Berli and colleagues 38 showed that management of ureteral complications posttransplant using ureteroneocystostomy, ureteroureterostomy, ureteropyelostomy, pyeloileostomy, and ureteroileostomy resulted in a high percentage of graft salvage, and compared with a matched control group, these potentially devastating complications do not worsen graft survival when performed by an experienced team. VUR in the transplant patient is common secondary to the technique of transplant ureteroneocystostomy.…”