Urological Complications in 1,000 Consecutive Renal Transplant Recipients

Abstract

The urological complications in the first consecutive 1,000 renal transplants at our transplant center are reported with a minimum followup of 12 months. The kidney was implanted in the iliac fossa in all cases and in all but 3 the ureter was inserted into the bladder with a Politano-Leadbetter technique. Overall, there were 71 primary complications in 68 patients (7.1%), which included 36 ureteral obstructions, 25 ureteral or bladder leaks (including ureteral necrosis), 7 bladder outflow obstructions, 2 ureteral stones and 1 case of symptomatic vesicoureteral reflux. The use of high dose steroids in the early years was associated with a 10% urological complication rate, which decreased to 4% in patients receiving low dose steroids thereafter combined with azathioprine or cyclosporine. The urological complication was corrected after 1 procedure in 65 cases and after 2 procedures in 4. No grafts were lost due to urological complications. Two patients died, 1 of sepsis following transurethral resection of the prostate and subsequent ureteral necrosis, and 1 of hemorrhage following nephrostomy tube insertion. Most ureteral complications were treated by an open operation, although in recent years endoscopic techniques have become more common. Meticulous retrieval technique, low dose steroid protocols and rapid diagnosis are the crucial factors associated with a minimal incidence of urological complications after renal transplantation.

Native pyeloureterostomy after kidney transplantation: experience in 48 cases

“…Unfortunately, the incidence of ureteral complications is more or less stable over the years, although this fact is well known and explant surgeons do their best to improve their explant procedures. High dose steroid therapy [30] and chronic rejection [13] are mentioned as further risk factors. Primary ureteral stenting can be a helpful tool, although ureteral problems can also occur in stented patients [7].…”

Laser endopyelotomie voor een zeldzame vorm van ureterobstructie na niertransplantatie

“…Meestal betreft het een obstructie van de distale ureter of van de ureterovesicale overgang. In een klein aantal gevallen is er sprake van een stenose ter plaatse van de proximale ureter of pyeloureterale overgang [2][3][4]6]. Deze obstructies worden toegeschreven aan littekenvorming en knikken van de ureter.…”

“…Deze obstructies worden toegeschreven aan littekenvorming en knikken van de ureter. De behandeling kan bestaan uit een open procedure met bijvoorbeeld het ontknikken van de ureter [4], pyelo-ureterostomie met gebruikmaking van de ipsilaterale, natieve ureter of een pyelumplastiek [3,6]. Minimale invasieve alternatieven zijn antegrade cold knife endopyelotomie [7] en monopolaire elektro-incisie met ballondilatatie (Acucise) [8][9][10].…”

“…Benjamin H. J. Doornweerd b.h.j.doornweerd@umcg.nl 1 afdeling Urologie, Universitair Medisch Centrum Groningen, Groningen, Nederland tie is obstructie van de getransplanteerde ureter. De meeste obstructies van de ureter treden op in de distale ureter; stenoses ter plaatse van de proximale ureter en de pyelo-ureterale overgang worden ook beschreven, maar zijn zeldzaam [2][3][4][5][6].…”

Chirurginės komplikacijos po inkstų transplantacijos

“…[8,21,22,23,24]. Dauguma tai persodinto inksto šlapimtakio striktūros arba šlapimtakio nesandarumas, kurių priežastis yra techninės klaidos arba išeminiai šlapimtakio pažeidimai išimant inkstą [39].…”