Urologic complications observed since the beginning of renal transplantation cause significant morbidity and mortality. In the first few years the procedure was performed incidence of urologic complications was reported to be 10% to 25%. Recently the incidence of urologic complications after renal transplantation has decreased to 2.5% to 12.5%; unfortunately a higher incidence exists in pediatric recipients reaching approximately 20% with an associated 58% and 74% graft survival rates for cadaveric and living-related transplantation respectively.
We retrospectively analyzed the postoperative urologic complications reported in the medical charts of 1523 consecutive kidney transplantations (1130 men. 74.2%; 393 women. 25.8%; mean age. 31.9 ± 10.9 years; range. 7 to 64 years; 354 cadaveric. 23.2%; 1169 living. 76.8%) performed by our team since 1975. The first 321 procedures took place at Hacettepe University Hospital in Ankara. Turkey and the remaining 1202 were performed at Baskent University Hospital in Ankara.
Urologic complications occurred in 46 (3%) recipients. Twenty-three (1.5%) of these patients had urine leakage. 15 (1%) had urinary obstruction due to ureteral stricture. 6 (0.4%) had distal ureter necrosis and 2 (0.1%) developed renal calculi in the late postoperative period. Twenty-four out of 46 required reoperation for urologic complications. The remaining 22 patients were treated conservatively in our interventional radiology department with excellent results.
In conclusion urologic complications will always occur in the posttransplant period. Early diagnosis by experienced personnel and use of interventional radiology can greatly reduce the need for surgical treatment.
We report the complication rate based on one urologist’s experience over a 9-year period including over 1000 ureteral reimplants performed at the time of kidney transplantation. Among 1083 ureteral reimplant operations there was a 4.3% urologic complication rate including a 2.7% ureteral stricture rate and a less than 1% rate each of urine leak ureteropelvic junction obstruction vesicoureteral reflux and clot obstruction.
The factors that lead to a low urologic complication rate are believed to be the use of short ureteral segment using the Lich (compared to the Politano-Leadbetter) technique and the routine use of indwelling stents. In addition a consistency in results was attributed to one transplant urologist performing all ureteral reimplants and managing all urologic complications.
Between November 1993 and December 2005 we performed 646 renal transplantation procedures in 373 males and 273 females of whom 81 were children. Kidney grafts were obtained from 461 living and 185 cadaveric donors. The medical records were retrospectively reviewed for urologic complications. Affected patients presented clinically with impaired kidney function: the diagnosis was confirmed by ultrasound scanning isotope renal scanning magnetic resonance urography and/or antegrade urography. Ureteric stricture was managed by percutaneous antegrade ureteric dilatation and stenting or by surgical reconstruction. Urine leak was treated by prolonged bladder drainage or surgical reconstruction. Renal stones were treated with extracorporeal shockwave lithotripsy.
The incidence of post-kidney transplant urologic complications was 4.8%. They were more common among male recipients and after cadaveric kidney transplantation. Although ureteric stricture presented late posttransplantation and was more common among children (4.23%) urine leak presented early and was more common in the elderly (4.69%). All urologic complications were successfully managed with no graft loss.
Related article:
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSTOPIC&_method=citationSearch&_piikey=S0090429507007224&_version=1&md5=98f8439b62ac397b561372b737f7b32b
comments | Add comment | Report as Spam
|
