Ureteropielostomía con vía nativa en el tratamiento de la uropatía obstructiva en el trasplante renal adulto. Experiencia y posibilidades técnicas

Trilla, E.; Lorenté, David; Salvador, C.; Planas, Jacques; Placer, J.; Celma, A.; Cantarell, C.; Moreso, Francesc; Serón, Daniel; Moróte, Juan

doi:10.1016/j.acuro.2014.02.004

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…and the characteristics of the patient. The intraperitoneal approach through a midline laparotomy seems to be preferred by many authors, especially for late procedures where retroperitoneal space may present intense fibrosis [18-20]. In our experience, a retroperitoneal access opening the previous ilioinguinal incision is viable and no intraoperative complications were described.…”

Section: Discussionmentioning

confidence: 66%

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Ureteral Stenosis and Fistula after Kidney Transplantation

Blanca¹,

Polo²,

Peña-Vallejo³

et al. 2022

Urol Int

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Introduction: Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. Methods: Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. Results: Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). Conclusion: Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.

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Section: Discussionmentioning

confidence: 66%

“…Regarding reconstruction with native ureter, there is controversy about performing nephrectomy of the native kidney [16, 19, 20, 23]. In our series, nephrectomy was not carried out in any patient previous or simultaneous to the surgical repair, and there were no complications related to the remaining kidney during follow-up.…”

Section: Discussionmentioning

confidence: 90%

Ureteral Stenosis and Fistula after Kidney Transplantation

Blanca¹,

Polo²,

Peña-Vallejo³

et al. 2022

Urol Int

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“…To perform an open surgical approach, it is important to have a correct knowledge of the characteristics of the stenosis and for this purpose a descending pyelography is essential. 5 Our group also advocates the performance of a late-phase contrast-enhanced computed tomography scan, if the patient’s renal function allows it, especially to evaluate extrinsic compressive causes.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent presentation is the finding of pyelocalyceal and ureteral dilatation with deterioration of renal function. In addition, there may be a possible associated infectious complication, with urinary diversion being the initial management, 5 and later performing a complete study of the urinary tract and propose a definitive solution. Minimally invasive techniques, such as balloon dilatation, are frequently used; however, their success rate is limited (45%-62%), 6 , 7 making definitive surgical techniques necessary.…”

Section: Introductionmentioning

confidence: 99%

Pyeloureteral Anastomosis as a Reconstructive Technique for Post-Renal Transplant Ureteral Stenosis

Parra,

Rivas,

Gutíerrez

et al. 2023

Urology Research and Practice

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Objective: Ureteral stenosis in renal transplant patients is a frequent urological complication that involves significant morbidity and may compromise graft function. Despite the common use of minimally invasive techniques, surgery continues to be the definitive treatment for ureteral stenosis, and pyeloureteral anastomosis is an infrequent but effective technique in the management of this pathology and has been described as a safe treatment with a low percentage of complications. Methods: This is a retrospective study of patients in whom surgical intervention via pyeloureteral anastomosis was carried out in our center in the last 12 years. A descriptive analysis of perioperative management, complications, and functional results is provided. A comparison of renal function at diagnosis and after surgery was made to evaluate the effectiveness of the procedure. Results: Thirteen patients underwent surgery within the described time frame. Time to diagnosis of stenosis was 60 days [interquartile range (IQR) 31-368]. Creatinine at diagnosis was 2.2 mg/dL [IQR 1.9-3] with a glomerular filtration rate, estimated by the modification of diet in renal disease equation, of 29 mL/min/1.73 m 2 [IQR 22.6-34.5]. Of these patients, 92.3% underwent percutaneous nephrostomy, and 38.5% also had a ureteral catheter. The mean duration of surgery was 265 minutes [IQR 240-300], and hospital stay was 9 days [IQR 7.5-16]. A double J was placed in all cases, which was maintained for 36 days [IQR 30-49]. Postoperative complications occurred in 15.4% of patients. Serum creatinine 1 year after surgery was 1.6 ± 0.4 mg/dL. Among the patients, 76.9% had no new pyelocalyceal dilatation on follow-up Doppler ultrasound scans at a mean follow-up time of 12 months. The restenosis rate was 23.1%, and all were successfully treated by endoscopic approach. There was an improvement in renal function figures at 1, 3, 6, and 12 months compared to renal function at diagnosis, both in terms of serum creatinine and glomerular filtration rate, with statistically significant results. Conclusion: Pyeloureteral anastomosis as a reconstructive technique of the urinary tract in renal transplant patients is an effective and reproducible technique with good long-term results.

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Independent risk factors for early urologic complications after kidney transplantation

Rahnemai‐Azar

Gilchrist

Kayler

2015

Clinical Transplantation

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Urologic complications are the most frequent technical adverse events following kidney transplantation (KTX). We evaluated traditional and novel potential risk factors for urologic complications following KTX. Consecutive KTX recipients between December 1, 2006 and December 31, 2010 with at least six-month follow-up (n = 635) were evaluated for overall urologic complications accounting for donor, recipient, and transplant characteristics using univariate and multivariate logistic regression. Urologic complications occurred in 29 cases (4.6%) at a median of 40 d (range 1-999) post-transplantation and included 17 ureteral strictures (2.6%), five (0.8%) ureteral obstructions due to donor-derived stones or intraluminal thrombus, and seven urine leaks (1.1%). All except two complications occurred within the first year of transplantation. Risk factors for urologic complications on univariate analysis were dual KTX (p = 0.04) and renal artery multiplicity (p = 0.02). On multivariate analysis, only renal artery multiplicity remained significant (aHR 2.4, 95% confidence interval 1.1, 5.1, p = 0.02). Donation after cardiac death, non-mandatory national share kidneys, donor peak serum creatinine > 1.5 mg/dL or creatinine phosphokinase > 1000 IU/L, and donor down time were not associated with urologic complications. Our data suggest that donor artery multiplicity is an independent risk factor for urologic complications following KTX.

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Ureteropielostomía con vía nativa en el tratamiento de la uropatía obstructiva en el trasplante renal adulto. Experiencia y posibilidades técnicas

Cited by 3 publications

References 17 publications

Ureteral Stenosis and Fistula after Kidney Transplantation

Ureteral Stenosis and Fistula after Kidney Transplantation

Pyeloureteral Anastomosis as a Reconstructive Technique for Post-Renal Transplant Ureteral Stenosis

Independent risk factors for early urologic complications after kidney transplantation

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