Negative Pressure Therapy May Delay Resolution of Urinary Leaks

Abstract

To the Editor: We read with interest the case report titled ‘Negative Pressure Wound Therapy used to Heal Urinary Fistula Wounds Following Renal Transplantation into an Ileal Conduit’ (1). We have employed negative pressure therapy (NPT) in over 100 renal transplant recipients with excellent results. However, we recently encountered an unusual case of a slow healing ureteral anastomosis in a patient managed with NPT. A 56-year-old man underwent kidney transplantation and subsequently developed a perinephric collection. After wound exploration and debridement, NPT was initiated. A screening renal scan was performed which was consistent with acute tubular necrosis with no evidence of leak. One week later, an analysis of the drainage fluid was consistent with urine. A repeat renal scan confirmed the diagnosis of a new urine leak. A urinary catheter was placed. An abdominal X-ray confirmed proper positioning of the double-J ureteral stent. After a week of conservative management, the leak persisted. At this point, we discontinued the NPT. Five days later, a nuclear scan confirmed complete resolution. The presence of fistulas is a known relative contraindication to NPT. We believe the NPT slowed healing of the neocystoureterostomy perhaps leading to the development of a urine leak. We also believe that the continued use of the NPT delayed the eventual resolution of this leak. We understand that this anecdote may be only an association, not definitive proof that NPT may slow healing of a neocystoureterostomy. Nevertheless, we maintain that NPT should be employed with caution in patients who may be at risk for urinary complications. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.