Diagnosis and Treatment of Urological Complications in Kidney Transplantation

Abstract

Between January 1973 and January 1990 we carried out 1,038 kidney transplantations using a transvesical end-to-side implantation of the ureter in the bladder without an antireflux mechanism. Moreover, 30 transplantations were done in 26 patients with a urinary diversion. We examined the urological complications in these 1,068 consecutive transplants. Urinary leakage and obstruction were the two main urological posttransplant complications. Severe leakage occurred in 21 patients (2.0%), and was treated by open surgery; 2 patients had a urinary diversion. The treatment of choice is a pyeloureterostomy (anastomosis between the transplant renal pelvis and the native ureter). There were 35 patients (3.3%) with severe ureteral obstruction of whom 5 had a urinary diversion. In 30 patients open surgical treatment of the obstruction was necessary and in 7 patients a percutaneous endourologic treatment was done (dilatation of a confined ureteral stricture in 6 patients and percutaneous stone treatment in 1). The postoperative mortality in the patients treated for leakage or obstruction was low: 4 patients (7%) died, 3 of septicemia due to leakage and 1 of pulmonary embolism after repair of the obstruction. The results of surgical treatment were good. The graft survival after 2 years in the group of urologically complicated transplants was 68% for the patients with leakage and 80% for those with obstruction. The 2-year graft survival in the patients without complications was 67% and 71 % for the patients with a urinary diversion. We conclude from these results that urological complications after renal transplantation can be treated successfully by surgical (or percutaneous) correction.

Urological Complications in Pediatric Renal Transplantation

“…Three of the eight patients with urinary leakage received kidneys from living related donors, including 1 with a disconnection of the ureter–bladder anastomosis. This higher frequency of urinary leakage in living related donors could be explained by the fact that the vascularization of the ureter is more easily damaged during donor nephrectomy as was suggested before [13, 17]and the extravesical reimplantation of the ureter although the group is relatively small.…”

“…Although rejection is the main cause of graft failure, urological complications can also play a role in graft loss and even patient mortality. The incidence of urological complications after kidney transplantation has been reported to range from 0 to 33% [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13], although data are not really comparable because some authors include only major urological complications, whereas others even include urinary tract infections. A higher rate of complications can be expected in children compared with adults, due to the higher number of patients with congenital urinary tract abnormalities often seen in combination with bladder dysfunction.…”

Native pyeloureterostomy after kidney transplantation: experience in 48 cases

“…Primary ureteral stenting can be a helpful tool, although ureteral problems can also occur in stented patients [7]. If graft dysfunction after transplantation occurs and graft rejection can be excluded the diagnosis can usually be matched by ultrasound and nuclear isotope scanning [5,24]. A main complication in the early phase after kidney transplantation is a leakage of the ureterocystostomy.…”

Urological Complications in Renal Transplantation

“…For ureteral implantation the meth od of transvesical ureteroneocystostomy without antireflux mecha nism was used as described earlier [5]. A transvesical ureteral split was left in situ for the first 5 postoperative days.…”

“…No renal grafts were lost due to a urological complication. infection leading to leakage and septicemia [5], Benoit et al [1] underlined the importance of preserving the ure teric vascularization and of a meticulous reimplantation technique as major factors in the prevention of urological complications. In general, kidneys with a long vein, a sin gle artery and a short ureteral segment are associated with a lower incidence of vascular impairment.…”