Treatment of ureteral complications after kidney transplantation with native ureteropyelostomy reduces the risk of pyelonephritis

Abstract

Urological complications contribute to morbidity and graft loss after kidney transplantation. Aim of this study was to assess the role of revisional surgery on patient outcome. From 1997 to 2007, 887 patients underwent kidney transplantation in our institution. Clinical data of patients with urological complications were analyzed. Ureteral complications were observed in 50 of 887 (5.6%) recipients, including ureteral necrosis (0.9%), stenosis (3.6%) and ureteral reflux with recurrent graft pyelonephritis (1.1%). Thirty-five patients underwent native ureteropyelostomy, and 14 patients had redo-ureterocystostomy. All patients treated for recurrent graft pyelonephritis had no further episodes. Overall, the rate of ureteral stenosis was significantly higher after secondary surgery, compared to the primary anastomosis (10% vs. 3.6%, p = 0.039). A significantly lower incidence of graft pyelonephritis was observed in patients after native ureteropyelostomy compared to patients treated with redo-ureterocystostomy (p = 0.019). In conclusion, reflux and recurrent graft pyelonephritis can be treated effectively by secondary surgery. The use of native ureteropyelostomy may offer protection from graft pyelonephritis after secondary surgery.

Native ureteropyelostomy: an effective therapy for urinary tract complications following kidney transplantation

“…Refashioning of the graft‐ureterocystostomy or suturing of smaller defects are therapeutic options. In case of failure of these limited surgical methods or in the presence of long ureteral strictures, ureteral leakage/ureteral necrosis, where total ureteric replacement is needed, ureteropyelostomy of the ipsilateral native ureter is an elegant surgical technique for reconstruction of the urinary tract . An advantage of the urinary tract reconstruction using the native ureter is the use of the physiologic anti‐reflux mechanism of the bladder.…”

Ureteral Reconstruction after Renal Transplantation: Clinical Outcome and Risk Factors

“…Lehmann et al found a symptomatic re-stenosis rate of 9% after native ureteropyelostomy and of 14% after neoureterocystostomy [11] .…”

Posttransplantation Vesicoureteral Reflux in Renal Grafts and Their Outcomes in Pediatric Transplantation: Should We Be Afraid ?

“…Although open surgical reimplantation is the reference treatment for symptomatic VUR with a success ratio of 83-100%, this procedure is difficult and has significant morbidities (17,18) . Endoscopic treatment is the minimal invasive procedure and it has 10% morbidity and 60-86% success ratio.…”