Surgical treatment of urologic complications in kidney transplantation

Debruyne, F. M. J.; Hoitsma, Andries J.; Arendsen, E.; Oosterhof, G.O.N.

doi:10.1007/bf00326619

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…In every patient with a normal bladder (n = 856), a transvesical ureteroneocystostomy without an antireflux mechanism was established and the ureter implanted in the fixed (dorsal) part of the bladder. Ureteral obstruction was observed in 29 patients (3.4%) [4]. Of these 29 patients, 5 had ureterovesical anastomotic stricture.…”

Section: Methodsmentioning

confidence: 97%

“…The standard therapy for ureteral obstruction Offprint requests to: G. O. N. Oosterhof after kidney transplantation is open operative reconstruction. The specific treatment of choice is pyeloureterostomy, which consists of an anastomosis between the pelvis of the transplanted kidney and the native ureter [4,18].…”

Section: Abstract: Endoscopic Dilation -Percutaneous Antegrade Dilationmentioning

confidence: 99%

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Antegrade percutaneous dilation of ureteral strictures after kidney transplantation

1989

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Ureteral obstruction after renal transplantation is due mostly to retroperitoneal fibrosis in the area of surgical dissection, and pyeloureterostomy is the treatment of choice for such an obstruction. For confined strictures, especially at the site of the ureteroneocystostomy, endoscopic dilation may be a good alternative. Antegrade percutaneous dilation was used to treat six patients with ureteral stricture after kidney transplantation. Four patients had stricture at the ureterovesical junction, one a confined midureteral stricture, and one a secondary stricture at the site of pyeloureterostomy. Percutaneous antegrade dilation of the stricture to 14 Fr with semirigid fascial dilators and external ureteral stenting with a 12-Fr silicon splint for 6 weeks was successful in the four patients with ureterovesical junction obstruction, but not in the two other patients. Results were judged on the basis of serum creatinine concentration, renal ultrasonography, and intravenous urography (IVU). The follow-up period was 12-20 months (mean 15 months). None of the six patients died and perioperative morbidity was minimal.

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Section: Methodsmentioning

confidence: 97%

Section: Abstract: Endoscopic Dilation -Percutaneous Antegrade Dilationmentioning

confidence: 99%

Antegrade percutaneous dilation of ureteral strictures after kidney transplantation

1989

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“…Antirejection therapy carried out in the pres ence of infection may lead to systemic infection and sub sequent septicemia, threatening not only the graft but also the patient. Rejection has become less common since the selection of patients has been made more accurate by newer matching techniques and since the introduction of ciclosporin as a new antirejection agent [2], On the other hand, we carry out increasingly more living-related-donor transplantations instead of cadaveric kidney transplants. Urinary leakage is likely to occur more frequently in these patients because the vascularization of the ureter is more easily damaged during donor nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The latter condition can mostly be treated conservatively by bladder drainage. Necrosis of the ureter may occur when an impaired vascu larization of the ureter is still worsened by (acute) vascular rejection [2], Immediate percutaneous drainage of the kidney and the urinoma is mandatory to prevent septic complications. At a later stage, open reconstructive sur gery, especially pyeloureterostomy, can be done.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Treatment of Urological Complications in Kidney Transplantation

Oosterhof

Hoitsma²,

Witjes³

et al. 1992

Urol Int

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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.

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