Urologic Problems in Renal Transplantation

Leary, Frank J.; Woods, John E.; DeWeerd, James H.

doi:10.1001/archsurg.1975.01360150068012

Cited by 47 publications

(12 citation statements)

References 12 publications

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“…More over, progress in the handling of immunosuppressive therapy with avoidance of overimmunosuppression as well as adequate diagnosis and management of urologie complications contributed to a considerable reduction of urologically related mortality rates. With these measures the incidence of urologie complications can be reduced to < 2 % without patient mortality [56,97], Thus Salvatierra et al [97] reported the incidence of urinary fistulas to be Edema Technical Periureteral fibrosis Ischemic fibrosis 'Immunologic' fibrosis Kinking Compression (lymphocele. hematoma, abscess, lower kidney pole, spermatic cord) Functional Calculi 0.5% in 540 and 2.2% in 860 consecutive renal transplan tations, without mortality.…”

Section: Incidence Causes and Relevance Of Ureteric Complicationsmentioning

confidence: 99%

Problems of the Distal Ureter in Renal transplantation

Dreikorn

1992

Urol Int

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The incidence and mortality rates of urologic complications in renal transplantation have decreased significantly during the last decade. This was achieved by improved techniques of donor nephrectomy with preservation of the ureteric blood supply and refined procedures for the reconstruction of the urinary tract. Intra- and extravesical ureteroneocystostomies have shown to be the most reliable and preferred techniques to restore the urinary tract continuity. Beside ureteral ischemia and technical failure ureteral rejection is increasingly accepted as an important contributory factor for the development of ureteric fistula and stenosis formation. Controversy still exists concerning the pathogenesis of reflux into the graft and its impact on long-term graft function. Percutaneous and endoscopic procedures have supplemented and partially replaced open surgical management of ureteric fistulas and stenoses. By adherence to the principles described the frequency of urologic complications and its associated mortality rates can be minimized.

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Section: Incidence Causes and Relevance Of Ureteric Complicationsmentioning

confidence: 99%

Problems of the Distal Ureter in Renal transplantation

Dreikorn

1992

Urol Int

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“…Ureteral complications are one of the most frequent issues encountered after kidney transplantation, in 2-26% of reported series [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. Ureteroneocystostomy is used routinely [13,14,15,16,17,24,25,30], ureteroureterostomy [19,20,22,34] and pyeloureterostomy [19] less frequently, and each technique has its pearls and pitfalls [29].…”

Section: Resultsmentioning

confidence: 99%

“…Most ureteral complications occur early in the postoperative course, and urinary fistula represents the most frequent one. In the late postoperative period, other concerns will be considered, including stenosis [23,29,30], cutaneous urinary fistulas [21,23,27,28,30], ureterolithiasis [26], periureteral abscess and fibrosis [18,33]. Imaging modalities will help to rule out these complications, in addition to a high index of suspicion.…”

Section: Resultsmentioning

confidence: 99%

Pseudorejection and True Rejection after Kidney Transplantation: Classification and Clinical Significance

Khater

Khauli²

2012

Urol Int

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Objectives: Multiple factors may result in an elevation in serum creatinine level after kidney transplantation, mimicking rejection. It is crucial to differentiate between a true rejection and other conditions inducing a ‘pseudorejection', in order to avoid overtreatment, or worse, mistreatment. Our goal was to review and classify true rejections and pseudorejections and their clinical significance. Material and Methods: This was a retrospective review of articles published in the USA and Europe, from 1976 to the present. The sites from which information was retrieved included PubMed, Clinical Imaging, Histopathology, Archives of Surgery, JACS, the American Urological Association, Medline and Springer Link. The importance of the resistive index will also be emphasized. Results: We reviewed 61 articles regarding the causes of renal graft dysfunction, which may be classified into true rejections and pseudorejections, the latter including the following 6 factors: hyperglycemia, ureteral obstruction, lymphocele, arterial stenosis, infection and recurrence of primary pathology. Conclusions: ‘Pseudorejection' has been described only once, for the first time in 1976 in the USA, and there have been no other reports since then. Multiple factors, mainly hyperglycemia, may induce a pseudorejection, presenting with an elevation of serum creatinine level and leading the clinician to an erroneous diagnosis of true rejection initially, resulting in inappropriate management.

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“…Acute ureteral obstruction of the transplanted kidney can cause deterioration in renal function and acute hyper tension [16]. Ureteral obstruction usually develops early after transplantation, but may occur later and present with oliguria and progressive deterioration in renal func tion.…”

Section: Dr Vito M Campesementioning

confidence: 99%