Ureteral obstruction following renal transplantation: causes, diagnosis and management

Kumar, Shankar; Ameli-Renani, Seyed; Hakim, Aishah; Jeon, Justyn Hwee; Shrivastava, Seema; Patel, Uday

doi:10.1259/bjr.20140169

Cited by 49 publications

(36 citation statements)

References 12 publications

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“…[22][23][24] Rates of urologic complications after kidney transplant range between 2.5% and 30% of all recipients. 22,23,[25][26][27] Urine leakage Urologic complications associated with the ureterovesical anastomosis after transplant may cause graft loss and mortality. Incidences of urinary leakage in different transplant centers have ranged from 0% to 8.9%, with incidences of ureteric stricture reported to range from 0.1% to 12.4%.…”

Section: Posttransplant Urologic Complicationsmentioning

confidence: 99%

“…26,28 Prompt diagnosis and remedial treatment are vital to prevent graft loss. Ureteric ischemia is the most common cause, accounting for around 90% of occurrences.…”

Section: Ureteral Obstructionmentioning

confidence: 99%

“…Ureteric ischemia is the most common cause, accounting for around 90% of occurrences. 26,28 The other causes are more then 2 arteries, long cold ischemia time, tumor, calculi, lymphocele, hematomas, abscess, kinking, and technical problems. Some occurrences of transplant ureteric stenosis may be associated with ureteric leak or necrosis ( Figure 10).…”

Section: Ureteral Obstructionmentioning

confidence: 99%

“…Metallic stents have been used to treat ureteral stenoses after failed balloon dilatation, but uroepithelial ingrowth has been a major issue with these devices. 24,26,28 If all of these methods are unsuccessful, surgical treatment should be applied. The options are to perform either a ureteral reimplantation or a 593 There are 3 different surgical techniques for ureteral stricture management occurring after renal transplant: (1) proximal transections of the anastomosis after anastomosis stricture and making ureteroneocystostomy; (2) excision of the strictured part and end-to-end ureteroureterostomy; and (3) ureteroureterostomy using the native ureter (ipsilateral or contralateral native ureter).…”

Section: Ureteral Obstructionmentioning

confidence: 99%

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2016

Exp Clin Transplant

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Since the first successful organ transplant conducted between twins in 1954, kidney transplant has evolved considerably over the past 50 years. Kidney transplant plays an important role in the treatment of end-stage kidney disease to improve the quality of life and prolong the life of patients. Despite significant advances, postoperative medical and surgical complications still represent important causes of morbidity and mortality. Many problems can be avoided through prophylactic correction of abnormalities detected during the preoperative evaluation; however, it is critical that technical mishaps at all stages of the transplant process (donor nephrectomy, benchwork preparation, and implant) be prevented and that careful postoperative monitoring be carried out, including thorough examination by attending physicians. However, despite these advances, surgical complications still present serious problems in kidney transplant recipients.

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Section: Posttransplant Urologic Complicationsmentioning

confidence: 99%

“…26,28 Prompt diagnosis and remedial treatment are vital to prevent graft loss. Ureteric ischemia is the most common cause, accounting for around 90% of occurrences.…”

Section: Ureteral Obstructionmentioning

confidence: 99%

Section: Ureteral Obstructionmentioning

confidence: 99%

Section: Ureteral Obstructionmentioning

confidence: 99%

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2016

Exp Clin Transplant

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“…This exploration represents the "criterion standard" imaging for locating the leak and for specifying its importance. 15 Table 3 summarizes the merits and disadvantages of the principal imaging types for urinoma analyses.…”

mentioning

confidence: 99%

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2018

Exp Clin Transplant

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Although they are not common, urologic complications after renal transplant are associated with risk of graft loss. Fluid collection during the postoperative period can be caused by urine leak or lymph leak of seroma. Biochemical analysis of the drained liquid is essential and should be compared with a concomitant serum sample. Surgical exploration is indicated if suspected urine leak is significant. Reimplantation of the ureter to the bladder can be challenging if there is extensive ureteral necrosis due to compromised vascularization. Key words: Diagnosis, Kidney transplant, Treatment, Urinoma, Urologic complication IntroductionComplications after renal transplant can be due to either medical or surgical reasons. Among early complications, surgical causes are significant, although they are less frequent than medical or immunologic causes. Delayed graft function is a common but nonspecifically important clinical problem.Fluid collection during the postoperative period can be caused by urine leak or lymph leak of seroma. In addition to clinical features, radiologic imaging can play a key role in ascertaining whether increased drainage fluid is because of urine leak or because of other causes in the posttransplant period. [1][2][3] Biochemical analysis of the drained liquid is essential and should be compared with a concomitant serum sample. In this review, we allude to various causes of increased fluid collection after kidney transplant, discuss different clinical presentations of urinoma, and describe an evidence-based management plan according to the leak source, anastomosis type, and the evolution of urine leak. Context SettingOur example patient is a 28-year-old male who underwent a kidney transplant from his brother with primary function. During the first 72 hours after transplant, the patient presented with increased drainage. Biochemical analysis of the drain showed high creatinine (16 000 μmol/L) and potassium levels (28 mmol/L) on aspirate fluid compared with a simultaneous analysis of a serum sample (creatinine of 416 μmol/L and serum potassium of 5.1 mmol/L). Causes of Fluid Collection After Kidney TransplantProductive drainage after kidney transplant can be associated with hemorrhage, lymphocele, perinephric abscesses, or urologic complications. 4,5 Hemorrhage Anticoagulation and antiplatelets increase the risk of bleeding after kidney transplant. 6 In the most obvious form of presentation, the diagnosis is evident because of a high amount of drain output of blood associated with signs of shock (a combination of tachypnea, hypotension, and tachycardia). In the immediate posttransplant period, a stable hemoglobin level or lack of clinical swelling does not exclude this diagnosis. Ultrasonography may show hematoma early after transplant. An urgent exploration is required even if there is a doubt that delayed graft function is related to bleeding.

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Intelligent Ureteral Stent for Early Detection of Hydronephrosis

Darestani

Shalabi

Lange

et al. 2021

Adv Materials Technologies

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Millions of people around the world currently suffer from kidney stone diseases. While ureteral stenting is an unmistakably effective treatment of these patients, their long‐term adverse effects can result in the build‐up of crystals around the stent. This, in turn, can lead to new ureter blockages that can dangerously increase kidney pressure, a condition known as hydronephrosis, which, if severe and prolonged, can cause irreversible kidney damage. Toward enabling early detection of hydronephrosis, this paper investigates the first intelligent ureteral stent with an integrated radiofrequency antenna and micro pressure sensor for resonance‐based wireless tracking of kidney pressure. Prototyping is conducted using a commercial ureteral stent as the substrate for microfabrication of the device. The packaged device is experimentally assessed for electrical characterizations and wireless pressure sensing using an in vitro test model. Preliminary telemetry testing demonstrates the fundamental ability of the device with its approximately linear responses of up to 1.7 kHz mmHg−1 over a pressure range of up to 120 mmHg in air, water, and artificial urine. These findings verify the efficacy of the device design and the approach to kidney pressure monitoring through indwelling stents, paving the way for the transfer of this technology to today's ureteral stent products.

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Ureteral obstruction following renal transplantation: causes, diagnosis and management

Cited by 49 publications

References 12 publications

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Intelligent Ureteral Stent for Early Detection of Hydronephrosis

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