Ureteral Complications in Human Renal Transplantation

Fjeldborg, O; Kim, C H

doi:10.1159/000279812

Cited by 24 publications

(7 citation statements)

References 10 publications

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“…Obstruction occurring beyond the first postoperative month remains frequent (2-7.5%) and mostly related to ureteral stenosis. The overall incidence of urologic complications in our series was low, which was comparable to those reported by other major centers (15-18). …”

Section: Discussionsupporting

confidence: 88%

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Impact of Ureteral Length on Urological Complications and Patient Survival After Kidney Transplantation

et al. 2013

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BackgroundUrologic complications are of the most important complications after kidney transplantation which increases mortality and morbidity significantly.ObjectivesWe designed this study to evaluate the association between ureteral length and postoperative complications.Patients and MethodsWe recorded the length of the transplanted ureter during the operation. Ureter-to-bladder anastomosis was performed using modified Lich-Gregoir method on the ureteral stent. Complications like urine leakage and increased creatinine were evaluated. We used both univariate and multivariate analyses and survival analysis according lengths of ureter. It means that the main variable is ureteral length and other variables are studied based on it.ResultA total of 395 patients with the mean age of 37 years (range, 18 to 68 years) were enrolled in the study, twenty six graft lost during the follow-up period. The Mean age of recipients was 37 ± 13 years. Urinary stenosis was seen in 6 patients (1.5%) and urinary leakage in 4 (1%) patients. The complication rate was not significantly different between these groups (P = 0.67). We found that there were no significant difference among complication (P = 0.25), hospitalization (P = 0.31) and survival (P = 0.84) at 5.5 cm length cut off.ConclusionsThe length of transplanted ureter does not affect the postoperative urologic complications (including urinary fistula and ureter-to-bladder anastomosis stricture), and it seems that decreased rate of complication frequency during the recent years is due to technical improvement, surgeon’s skillfulness and development in use of immunosuppressant’s postoperatively.

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Section: Discussionsupporting

confidence: 88%

“…Complications vary from around 20% to less than 5% (15, 16). At many transplantation centers, surgeons have adopted new suture techniques.…”

Section: Discussionmentioning

confidence: 99%

Impact of Ureteral Length on Urological Complications and Patient Survival After Kidney Transplantation

et al. 2013

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“…Wegen der hohen Komplikationsrate der drei letztgenannten hat sich die Uretercystoneostomie in der Modifikation nach Woodruff oder Politano-Leadbetter allgemein durchgesetzt [5,7,12,13]. Wegen der hohen Komplikationsrate der drei letztgenannten hat sich die Uretercystoneostomie in der Modifikation nach Woodruff oder Politano-Leadbetter allgemein durchgesetzt [5,7,12,13].…”

Section: Ursachenunclassified

“…Bei der Entnahme sollte unbedingt das Fett in der Umgebung des Nierenbeckens geschont werden, da es ftir die Blutversorgung des Ureters wichtige Gef~iBe enthNt [2,9]. [5] geschlossen werden, die bei Leichennierentransplantationen eine gr6Bere Rate an Ureterkomplikationen sahen als bei der Verwandten-Transplantation. Inwieweit AbstoBungsreaktionen einen Einflul3 auf Ureterkomplikationen haben, wird unterschiedlich beurteilt [4,7].…”

Section: Ursachenunclassified

Fr�he Ureterkomplikationen nach Nierentransplantation

Löbermann¹,

Dostal²,

Schreiber

et al. 1979

Langenbecks Arch Chiv

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Ureteral complications occurred in 23 cases after 225 renal transplantations. The complications consisted of 17 urinary fistulas and 6 stenoses of the ureter. Fourteen of the urinary fistulas were successfully treated by conservative management. Two transplants were lost secondary to operation because of ureteral obstruction. Factors contributing to ureteral leakage were the technique of ureteral anastomosis, the handling of the donor ureter during donor nephrectomy and possibly ureteral necrosis by rejection crises. Ureteral stenosis and rejection crisis may have the same symptoms. Urinary fistulas can easily be observed by the urine extravasation. The treatment of urinary fistulas can be managed only by replacing the suprapubical drainage. The stenosis of ureter with subsequent deterioration of graft function needs an operation with the danger of loss of the transplanted kidney.

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“…Owing to the anatomical features of the ureter, the branches of its arteries are small and are easily injured because of tearing (9). Currently, no accurate method exists for diagnosing vascular compromise of the ureter, necessitating an attempt to identify a method for assessing the ureter during KT by determining the area of the ureter that has insufficient blood supply before ureter anastomosis is performed (7,8,10).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative assessment of ureter perfusion after revascularization of transplanted kidneys using intravenous indocyanine green fluorescence imaging

et al. 2021

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Background: Kidney transplantation is the most valuable renal replacement therapy. One of the most common urologic complications following kidney transplantation is ureter anastomosis leakage, which leads to high morbidity along with kidney graft loss. We hypothesized that indocyanine green (ICG) fluorescence videography can assess ureter perfusion after revascularization of transplanted kidneys.Methods: We conducted a prospective cross-sectional study in end-stage renal disease patients who underwent deceased donor kidney transplantation at Ramathibodi Hospital from September 2019 to January 2020. The segments of transplanted ureters were categorized as having good or poor perfusion based on the percentage from ICG fluorescence videography images. Then the results from ICG fluorescence videography were compared with histopathology which is considered the gold standard.Results: Thirty-one sections of dissected ureters were evaluated from 10 patients. Compared with pathological diagnosis of ureteral ischemia, ICG videography had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio of 100%, 92.6%, 66.7%, 100%, and 14, respectively. Accuracy was 93.6%. The area under the curve of ICG fluorescence videography was 0.96. The average ureter length that maintained good perfusion was 14 cm from the ureteropelvic junction.Adverse events from ICG were not observed in this study. Conclusions:We conclude that ICG fluorescence videography is beneficial for detection of early ureteral ischemia in kidney transplantation patients, with negligible adverse events. However, further studies with larger numbers of patients are necessary to confirm our results and clinical outcomes regarding complication rates.

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Ureteral Complications in Human Renal Transplantation

Cited by 24 publications

References 10 publications

Impact of Ureteral Length on Urological Complications and Patient Survival After Kidney Transplantation

Impact of Ureteral Length on Urological Complications and Patient Survival After Kidney Transplantation

Fr�he Ureterkomplikationen nach Nierentransplantation

Intraoperative assessment of ureter perfusion after revascularization of transplanted kidneys using intravenous indocyanine green fluorescence imaging

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