Primary reconstruction is a good option in the treatment of urinary fistula after kidney transplantation

Mazzucchi, Eduardo; Souza, Guilherme L.; Hisano, Marcelo; Antonopoulos, Ioannis; Piovesan, Affonso; Nahas, William Carlos; Lucon, Antônio Marmo

doi:10.1590/s1677-55382006000400003

Cited by 21 publications

(23 citation statements)

References 9 publications

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“…Recipient age, site of arterial anastomosis, and preexisting bladder conditions also have been cited as factors that predispose patients to urine leak. 19 Nie and associates 9 reported an association between urine leak and deceased donors and patients with diabetes. However, Maricic and associates 8 did not differentiate complication by donor type or comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Suttle

Fumo²,

Baghmanli³

et al. 2016

Exp Clin Transplant

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Objectives: Transplant surgeons use a myriad of ureteral anastomotic techniques in renal transplant. Although the Lich-Gregoir extravesical anastomosis is the most common, ureteroureterostomy also is used. In this meta-analysis, our objective was to compare the complication rates of these 2 techniques as reported in the literature. Materials and Methods: A systematic review of the literature revealed 44 articles, 6 of which met our inclusion criteria. Studies were compiled using Review Manager (RevMan version 5.3, Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, Denmark). Forest plots were generated to assess relative risk. A fixedeffects model was used for low heterogeneity, and a random-effects model was used for high heterogeneity. Results: Overall complications were similar for both procedures (relative risk, 1.22; 95% confidence interval, 0.9-1.65), as were rates of urine leak and fistula (relative risk, 0.79; 95% confidence interval, 0.17-3.64) and hematuria (relative risk, 0.24; 95% confidence interval, 0.001-4.84). Stricture, obstruction, and stone formation were more common after ureteroureterostomy (relative risk, 0.63; 95% confidence interval, 0.45-0.88), whereas vesicoureteral reflux (relative risk, 6.82; 95% confidence interval, 1.68-27.61) and urinary tract infection (relative risk, 2.29; 95% confidence interval, 1.3-4.03) were more common after ureteroneocystostomy. Conclusions: With similar overall complication rates, both procedures can be viewed as being acceptable primary anastomotic techniques. In light of differing individual complication rates and the scarcity of data comparing the 2 methods, no specific recommendation regarding that technique should be used can currently be elucidated. We believe that further prospective studies comparing ureteroneocystostomy and primary ureteroureterostomy may reveal which is superior regarding complication rates.

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Section: Discussionmentioning

confidence: 99%

Untitled

Suttle

Fumo²,

Baghmanli³

et al. 2016

Exp Clin Transplant

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“…Outlining their algorithm, Mazzucchi et al recommend primary reconstruction whenever possible. When local tissue conditions or the patient's overall clinical status do not allow for reconstruction at the time of initial exploration, ligation above the fi stula and nephrostomy drainage are suggested, with defi nitive reconstruction performed at a later time, 3 as was our approach in this case. For distal ureteral necrosis, revision of the ureteroneocystotomy is advocated, as it obviates the need for dissection of the transplanted kidney itself.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Ureteral necrosis, in particular, complicates 2%-3% of these procedures. 3,4 An extreme variant of this phenomenon, necrosis of the entire allograft ureter and renal pelvis, is a particularly unusual but potentially devastating complication of renal transplantation that can result in signifi cant morbidity-including graft loss-as well as mortality. 3,5 As the demand for renal allografts far outweighs the current supply, preservation of the renal allograft must remain a high priority.…”

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confidence: 99%

“…3,4 An extreme variant of this phenomenon, necrosis of the entire allograft ureter and renal pelvis, is a particularly unusual but potentially devastating complication of renal transplantation that can result in signifi cant morbidity-including graft loss-as well as mortality. 3,5 As the demand for renal allografts far outweighs the current supply, preservation of the renal allograft must remain a high priority. We report a novel reconstructive approach successfully utilized to salvage a renal allograft after necrosis of the ureter and renal pelvis.…”

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confidence: 99%

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Ureterocalicostomy to Salvage a Renal Allograft with Pyeloureteral Necrosis

Pais

Clark

Lucas

2008

Dialysis & Transplantation

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Necrosis of an allograft's renal pelvis and ureter is an uncommon but potentially devastating complication of renal transplantation. Although its occurrence may result in signifi cant morbidity-including graft loss-or mortality, reconstruction of the collecting system may save the transplanted kidney. We present a case of successful renal allograft salvage despite necrosis of the renal pelvis and ureter, utilizing a modifi ed ureterocalicostomy.

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“…Ureteral stenting alone is used exceptionally. All patients received prophylactic or therapeutic antibiotic according to the antibiogram of the collected fluid (Mazzucchi E, 2006). The need for immediate open operative surgical intervention has been replaced, to a large extent, by early endourologic intervention (Banowsky LHW, 1991).…”

Section: Management Of the Urinary Fistulamentioning

confidence: 99%