Incidence Of Urological Complications Research Articles

Empleo del catéter doble J para la prevención de las complicaciones urológicas en el trasplante renal

ObjetiveTo analyze the impact of the use of the double J stent in the incidence of urological complications, like fistula urinary and ureteral obstruction in kidney transplants. Materials and methodsBetween August 2003 and December 2005, 59 adult recipients underwent renal transplant. A retrospective study was conducted on two groups of patients: Group A with double J stent and group B without it. We reviewed the urological complications: fistula, ureteral obstruction and urinary tract infection. ResultsGroup A: One ureteral obstruction and two urinary fistulas (7%) were developed in this group. 13 patients (46%) had a positive urinary culture. In only one case was necessary to retire the double J stent because of ureteral obstruction. Group BFour patients (13%) developed ureteral obstruction and another five (16%) developed urinary fistula. 9 patients (29%) had a positive urinary culture. ConclusionThe routine insertion of a double J stent in kidney transplants reduces the number of early complications urinary fistula and ureteral obstructions.

Urologic Complications in 1523 Renal Transplantations: The Baskent University Experience

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.

Urologische Komplikationen nach Nierentransplantation

Between August 1981 and May 2005, 1065 consecutive kidney transplants were performed at our center; 393 patients (36.9%) developed urological complications in the first 60 postoperative days. Urinary tract infections occurred in 28.5% of all patients. The major urological problems seen were urinary leakage and ureteral obstruction in 6.2% and 1.4% of the patients. Two grafts were lost due to severe urinary leakage. No patient death occurred due to urological complications. The incidence of urological complications is mainly influenced by the surgical procedure of organ retrieval and ureteroneocystostomy. With double-J stenting of the extravesical ureteroneocystostomy, we observed a significantly lower rate of urinary leakage but a higher rate of urinary tract infections in our series. Early diagnosis and treatment of urological complications may prevent further morbidity of our transplant patients.

Surgical complications in live‐donor pediatric and adolescent renal transplantation: Study of risk factors

To report the surgical complications among our pediatric and adolescent renal transplants and to analyze the different factors that may influence the occurrence of such complications. A total of 250 pediatric and adolescent renal transplants were included in this study. Of these patients, there were 154 boys and 96 girls with a mean age of 15.4+/-3.7 yr (range 5-20 yr). All patients received their kidneys from living donors. Four patients underwent renal retransplantation. Surgical complications were reported and their incidence was correlated with several pretransplant, technical and post-transplant risk factors by both univariate and multivariate analyses. The impact of surgical complications on graft and patient survival was computed using the Kaplan-Meier technique. Among the 250 patients, 35 surgical complications were encountered in 33 patients. These complications included urinary leakage in 10 patients, ureteric stricture in 11 patients, complicated lymphocele in eight patients, hematoma necessitating surgical exploration in two patients, wound dehiscence in one patient, stone of the graft ureter in one patient and renal artery stenosis in two patients. The incidence of urological complications (ureteral stenosis, urinary leakage and stone disease) was 8.8% and vascular complications 0.8%. Small ureteric leakage (four patients) was treated by endourologic techniques, whereas leaks associated with ureteral necrosis required open revision. Endourologic treatment was attempted in early and mild cases of ureteric obstruction. In late and severe cases, surgery was performed. On univariate analysis, the factors that significantly affected the incidence of surgical complications were recipient's age, lower urinary tract abnormalities, the type of primary urinary recontinuity, the time to diuresis, and height and weight of the patients. On multivariate analysis, the type of primary urinary continuity was the only factor that sustained statistical significance. Neither patient nor graft survival was affected by the occurrence of surgical complications. Primary urinary continuity is the only risk factor that affects the incidence of surgical complications among pediatric and adolescent live donor renal transplants, with the extravesical technique of Lich-Gregoir providing the best results. Surgical complications in pediatric and adolescent renal transplantation can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication is paramount to graft and patient survival.

UROLOGICAL COMPLICATIONS AFTER KIDNEY TRANSPLANTATION: INCIDENCE AND RISK-FACTORS

P309 Aims: The purpose of this study was to determine the incidence and management of urological complications. The possible risk factors from donor, graft and recipient for were ascertained for development of urological complications. Methods: Between 1992 and 2004, 974 patients underwent renal transplantation in our hospital. The patients with urological complications from this group were compared to a random sample of 357 patients without urological complications. Donor, graft and recipient characteristics, as well as implantantion procedure were scored. The incidence and type of complication were described and risk factors for urological complications were determined by chi-square tests and univariate analysis. Results: There were 78 (8.0 %) patients with urological complications. The complications were urinary leakage in 14 (1.4%), ureteral obstruction in 25 (2.6%), stenosis in 22 (2.3%) and hydronefrosis in 17 (1.7%). Age and cause of death were not related to urological complications. A relevant risk-factor for development of urological complications was mean systolic blood pressure of donor during last 24 hours. Two and threeway interactions were found for urine output in the last hour, systolic blood pressure and the occurence of hypotensive episodes. Ureter, venous and arterial abnormalities were not related to urological complications, nor were atherosclerosis, vascular problems or surgical bleeding. Conclusions: The incidence of urological complications was 8%. Urine output, systolic blood pressure and the occurence of hypotensive episodes of the donor combined have a strong additive effect on the occurence of urological complications. Donor and recipient characteristics and implantation problems showed no relation with the occurence of urological complications.

SURGICAL COMPLICATIONS IN LIVE-DONOR PEDIATRIC RENAL TRANSPLANTATION: STUDY OF RISK FACTORS

P690 Aims: To report the surgical complications among our pediatric renal transplants and to analyze the different factors that may influence the occurrence of such complications. Methods: A total, 250 pediatric renal transplants were included into this study. Of these children there were 154 boys and 96 girls with a mean age of 15.4 ± 3.7 years (range 5 to 20). All patients received their kidneys from living donors. Four patients underwent repeat renal transplantation. Surgical complications were reported and their incidence was correlated with several pre-transplant, technical and post-transplant risk factors by both univariate and multivariate analyses. The impact of surgical complications on graft and patient survival was computed using the Kaplan-Meier technique. Results: Among the 250 patients, 35 surgical complications were encountered in 33 patients. These complications included urinary leakage in 10 patients, ureteric stricture in 11, complicated lymphocele in 8, hematoma necessitating surgical exploration in 2, wound dehiscence in 1, stone of the graft ureter in 1 and renal artery stenosis in 2. The incidence of urological complications (ureteral stenosis, urinary leakage and stone disease) was 8.8% and vascular complications 0.8%. Small ureteric leakage (4 patients) was treated by endourologic techniques, whereas leaks associated with ureteral necrosis required open revision. Endourologic treatment was tried in early and mild cases of ureteric obstruction. In late and severe cases, surgery was performed. On univariate analysis the factors that significantly affected the incidence of surgical complications were recipient’s age, lower urinary tract abnormalities, the type of primary urinary recontinuity, the time to diuresis, height and weight of the patients. On multivariate analysis, the type of primary urinary continuity was the only factor that sustained statistical significance. Neither patient nor graft survival was affected by the occurrence of surgical complications. Conclusions: Primary urinary continuity is the only risk factor that affects the incidence of surgical complications among live-donor kidney pediatric renal transplants, with the extravesical technique of Lich-Gregoir giving the best results. Surgical complications in pediatric renal transplantation can be minimized if basic principles of careful transplant technique are used. Prompt identification and treatment of any complication are paramount to graft and patient survival.

The urological complications of renal transplantation: a series of 1535 patients.

To determine the incidence of urological complications of renal transplantation at one institution, and relate this to donor and recipient factors. A consecutive series of 1535 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Leadbetter-Politano anastomosis was the preferred method of ureteric reimplantation. There were 45 urinary leaks, 54 primary ureteric obstructions, nine cases of ureteric calculi, three bladder stones and 19 cases of bladder outlet obstruction at some time after transplantation. The overall incidence of urological complications was 9.2%, with that for urinary leak or primary ureteric obstruction being 6.5%. One graft was lost because of complications, and there were three deaths associated directly or indirectly with urological complications. There was no association with recipient age, cadaveric vs living-donor transplants, or cold ischaemic times before organ reimplantation, although the donor age was slightly higher in cases of urinary leak. There was no association with kidneys imported via the UK national organ-sharing scheme vs the use of local kidneys. The management of these complications is discussed. The incidence of urological complications in this series has remained essentially unchanged for 20 years. The causes of these complications and techniques for their prevention are discussed.

Urological complications after living‐donor renal transplantation

To determine the incidence and management of urological complications after 1200 consecutive live-donor renal transplantations, all of which were carried out in one centre; the possible risk factors and the effect on patient and graft survival were also assessed. Data were retrieved from an electronic database; the incidence of urological complications was determined, and correlated with relevant risk factors by univariate and multivariate analysis. The effect on patient and graft survival was assessed using Kaplan-Meier statistics. There were 100 complications in 96 patients (8%); urinary leaks occurred in 37, ureteric strictures in 23 and lymphoceles causing ureteric obstruction in 17. Percutaneous needle biopsy was complicated by haematuria and clot anuria in six patients. Late complications included 11 cases of stones, four of bladder malignancy and two of haemorrhagic cystitis. There was evidence that the age of the recipients (< 10 years), method of establishing urinary continuity (uretero-ureteric anastomosis) and a high dose of steroids had an independent positive effect on the incidence of urological complications. However, their development did not influence graft or patient survival. When there is meticulous attention to the technical details, renal transplantation should incur few urological complications. Early intervention with percutaneous drainage reduces morbidity and the likelihood loss of graft function. Proper and prompt management should not affect the graft and/or the patient's survival.

Estudio comparativo entre anastomosis ureteral con o sin cateterización con doble j en trasplante renal

To analyze the impact of the use of the routine double-J stent in the incidence of urological complications, like fistula, stenosis, ureteral obstruction and urinary tract infection. A retrospective study was conducted on two groups of patients: 28 without double-J stent and 28 with it. We reviewed urological complications: stenosis, fistula and obstruction. We paid special attention to urinary tract infection and other inherents complications to the use of double-J stents. A patient from the double-J stended group (3.6%) developed a urinary fistula and there were no obstructions. 13 patients (46.6%) had a positive urinary culture in the first month post RT. Two urinary fistulas and 4 obstructions were developed in the non-stended group. Six major complications of the urinary tract. 14 patients (50%) had a positive urinary culture in the first month post RT. The use of double-J stent across uterovesical anastomosis decreases the post-RT ureteral complications. Stent placement does not increase the risk of urinary tract infection in the early post-RT.

Urologic complications in renal recipients

MARKED improvement in recipient and graft survival as well as decreased mortality and morbidity rates have made renal transplantation the treatment of choice for end-stage renal disease. The incidence of urologic complications after renal transplantation has ranged from 2.5% to 14.7%, with a higher incidence in pediatric recipients reaching approximately 30%. Urologic complications represent an important cause of morbidity delaying normal functioning of the graft and in some cases leads to the loss of the graft and/or the death of the patient. Although not unanimously affirmed, the technique of uretroneocystostomy used does not seem to influence the incidence of complications. We report urologic complications in 151 consecutive renal transplantations.

A RANDOMIZED STUDY AND COST ANALYSIS OF ROUTINE URETERAL STENTING IN RENAL TRANSPLANTATION

297 Although ureteral stenting is a common practice for ureteral implantation in general urology, its use in renal transplantation (RT) is controversial. Objective. To analyze the costs and benefits of ureteral stenting on the incidence of urological complications in RT in a randomized trial. Methods. Patients with normal urinary tracts undergoing RT at a single centre were eligible. The ureter was trimmed to permit a nonredundant, tension-free anastomosis. If problems that mandated ureteric stenting had been identified at this point, patients were excluded from randomization (3 patients). Otherwise, patients were randomized to receive routine ureteric stenting or to stenting only in the event of anastomotic complications. Lich-Gregoir ureteroneocystostomy was performed. We also performed a cost analysis considering the cost of the stent, supplies, cystoscopy, surgeons' and anesthetists' fees. Results. Between June 1994 and Oct 1997 we performed RT in 331 eligible patients, of whom 280 were enrolled. 143 patients were randomized to stent (S) and 137 to no stent (NS). Groups were comparable in terms of donor and recipient age, sex, donor source, first or second graft, original disease and immunosuppression. Ureteral length after trimming was 6.6 ± 1.4 cm in S and 6.4 ± 2.0 cm in NS (p=0.33). Six patients in NS (4.4%) were stented after randomization for intraoperative events that in the surgeon's opinion required stent: difficult anastomosis (3); twisted ureter (2); or leak (1). In an intention-to-treat analysis we found no difference between groups in patient outcome. (Table)TableAll complications were successfully managed by percutaneous stent placement or surgery and there was no graft loss secondary to ureteral complications in either group. Only one patient in group A required general anesthesia for stent removal. The cost analysis showed that routine stenting was associated with excess costs of $210 CDN per patient. Conclusions. Routine ureteral stenting may not be necessary in renal transplantation. A policy of selective stenting may be associated with equally good outcomes at reduced cost.

Complications relating to the urinary tract associated with bladder-drained pancreatic transplantation.

To evaluate the incidence and management of the urological complications after bladder-drained pancreatic transplantation. A retrospective study was carried out on 24 consecutive bladder-drained pancreatic transplants in 24 patients with type I insulin-dependent diabetes mellitus, 22 with simultaneous kidney transplants and two of pancreas alone, over a period of 53 months. All 24 patients were alive within a mean follow-up of 26.7 months: 22 patients have functioning pancreatic grafts and are insulin-independent. The overall incidence of urological complications was 83% (20 of 24 patients) and 14 patients had more than one complication. The major non-infective complication was haematuria (eleven), which was treated conservatively, with only two patients requiring enteric conversion. One patient developed a duodeno-vesical fistula and lost the functioning pancreatic graft as a consequence. Other non-infective complications were urethritis (one) and urethral stricture (one), which were managed with catheter drainage and internal urethrotomy, respectively, and vulval ulcers (one) and reflux pancreatitis (one) treated conservatively. The main infective complications were recurrent lower urinary tract infection (nine), asymptomatic persistent bacteriuria (nine), prostatitis and epididymitis (one), and pyelonephritis (one), all managed with appropriate antibiotics. Three patients developed septicaemia from urosepsis and were treated successfully with antibiotics. Two patients developed genital warts and were treated with laser vaporization. Although bladder drainage has significantly contributed to the increasing success of pancreatic transplantation, urological complications are frequent and can be serious and life-threatening. As more of these procedures are performed urologists need to be able to recognize and treat these problems.

Late ureteral obstruction after kidney transplantation.

Abstract Today, the incidence of urological complications following renal transplantation is 2 %-10 %. Most of these complications occur within the 1st year and affect the distal ureter. We report on two patients who developed very late ureteral obstruction, 14 and 18 years after transplantation. Both patients had rejection episodes 1 and 10 months prior to the ureteral stenosis. Histological examination of one resected ureter revealed findings strongly suggestive of a rejection process. Open surgery with antirefluxive reimplantation into the bladder was successful in both patients, with a postoperative observation time of 20 and 8 months, respectively. We conclude that a percutaneous nephrostomy may be required in patients with rising creatinine and incipient hydronephrosis even long after transplantation has been performed.

Correlation of Preoperative Urodynamic Findings to Postoperative Complications Following Pancreas Transplantation

Urological complications are common following pancreas transplantation with bladder drainage. Some investigators have excluded patients from pancreas transplantation because of abnormal preoperative urodynamics. To determine the risk of an abnormal bladder in bladder-drained pancreas transplantation, we prospectively evaluated 23 type I diabetic patients undergoing pancreas transplantation with preoperative urodynamics. For study purposes, criteria for an abnormal urodynamic evaluation were a bladder capacity of greater than 1,000 cc, absence of normal detrusor contractility and an abnormal voiding pattern. In addition, an abnormal study was defined by the presence of 2 or more of the following: 1) suppressed proprioception at 250 cc or at a volume of greater than 50% of bladder capacity, 2) peak flow of less than 10 cc per second, 3) interval to peak flow of greater than 30seconds or 4) post-void residual of greater than 150 cc.Of the 23 patients 10 (43%) had abnormal preoperative urodynamic studies. All 23 patients underwent pancreas transplantation with bladder drainage, alone or in combination with a kidney transplant. The incidence of urological complications was 3.1 and 3.4 per patient, respectively, in the normal and abnormal groups (p = 0.126). Patient and graft survival rates were similar between the 2 groups (p >0.5). We were unable to show that abnormal preoperative urodynamic studies preclude successful pancreas transplantation with bladder drainage or predict an increase in postoperative complications.

Fate of upper urinary tracts in patients with indwelling catheters after spinal cord injury

Several modes of urinary tract drainage exist for the spinal cord-injured (SCI) patient, but the use of an indwelling catheter is discouraged. We retrospectively reviewed the charts of our traumatic SCI patients followed twenty years or more since initial injury to compare urinary tract preservation and the incidence of urologic complications in patients with neurogenic bladders voiding spontaneously with those using long-term indwelling catheters. Eighty-one patients with long-term injuries were identified; 73 of them fit the study criteria. Forty-one patients voided spontaneously having a balanced bladder or performing intermittent catheterization or have undergone sphincterotomy or vesicostomy, and 32 had indwelling suprapubic or Foley catheters. Renal function measured by creatinine clearance was similar in both groups: 81.3 ± 20.2 mL/min for spontaneous voiders and 83.7 ± 24.9 mL/min for catheterized patients. Review of urinary tract imaging and incidence of complications in both groups was very comparable, with the exception that the catheterized group had a higher prevalence of scarring and calicectasis on radiologic imaging of the upper urinary tracts which was statistically significant. Of the remaining population, in 6 of 81 patients, bladder cancer developed, and they underwent radical cystectomy and urinary diversion and 2 had proximal diversion alone. Of the 6 patients with bladder cancer, 2 were spontaneous voiders with transitional cell carcinoma (TCC) developing. Three of the 6 patients had indwelling catheters: in 1 patient TCC developed, in 1 adenocarcinoma, and in 1 squamous cell carcinoma. In 1 patient TCC developed in a defunctionalized bladder after ileal conduit formation. Based on this study, we can conclude that in select groups of SCI patients, the choice of an indwelling catheter may be made if other methods fail, provided patients undergo regular upper urinary tract imaging and cystoscopy.

Urological Complications Following Live Donor Kidney Transplantation: Effect of Urinary Schistosomiasis

Summary— Urological complications were studied in 310 live donor kidney transplants. All recipients and donors were investigated for urinary schistosomiasis by examining tissue obtained intra-operatively from the donor's ureter or the patient's bladder. Schistosomiasis was histologically documented in 76 cases (patient's bladder (46), donor's ureter (9), both (21)). The incidence of urological complications was 11/76 (15%) in the schistosomal group and 14/234 (6%) in the non-schistosomal group; this was statistically significant. Among the schistosomal patients, the site of infestation had no statistically significant effect on the incidence of urological complications. No deaths or graft losses were directly attributable either to these complications or to their surgical correction.

Urological complications following live donor kidney transplantation: effect of urinary schistosomiasis.

Urological complications were studied in 310 live donor kidney transplants. All recipients and donors were investigated for urinary schistosomiasis by examining tissue obtained intra-operatively from the donor's ureter or the patient's bladder. Schistosomiasis was histologically documented in 76 cases (patient's bladder (46), donor's ureter (9), both (21)). The incidence of urological complications was 11/76 (15%) in the schistosomal group and 14/234 (6%) in the non-schistosomal group; this was statistically significant. Among the schistosomal patients, the site of infestation had no statistically significant effect on the incidence of urological complications. No deaths or graft losses were directly attributable either to these complications or to their surgical correction.

The disease pattern and causes of death of spinal cord injured patients in Japan.

In recent years, the lifespan of patients with spinal cord injury (SCI) in Japan has been markedly prolonged, resulting in changes in the pattern of diseases developing after SCI and causes of death. We carried out a questionnaire survey on these problems and obtained the following results: 1. Disease pattern in SCI patients. The morbidity during 3 days in October 1987 and the past history after SCI were investigated in 426 SCI patients, and the results were compared with those in the national health survey carried out by the Japanese government in 1984. The incidence of urological complications and pressure ulcer was high, as was to be expected. In addition, the incidence of diabetes, hypertension, skin diseases, peptic ulcer, and hepatic disease were also significantly higher in the SCI patients. 2. Causes of death in SCI patients. Causes of death were analysed in 522 SCI patients who died, and the results were compared with those of the survey undertaken in 1967. The major causes of death were urinary tract infections and respiratory dysfunction in the early stage of cervical cord injury. Comparison with the results of the survey in 1967 showed a significant decrease in deaths from urinary tract infection; and a significant increase in those from CVA.

The Manifestation and Management of Late Urological Complications in Renal Transplant Recipients: Use of the Urological Armamentarium

The incidence of urological complications in renal transplant patients is well documented. The majority of these complications occur in the early postoperative period; late occurrences (more than 3 months) are much less common.We have had experience with 7 patients who presented with late complications 3 months to 7 years after transplantation: ureteral obstruction occurred in 4 patients, ureteral disruption or laceration in 2 and neurogenic bladder with hydronephrosis in 1. Management of these patients has been varied and has included cystoscopic stent placement, Boari flap, ureteropyelostomy, ureteroneocystostomy, bladder augmentation and urinary undiversion. Grafts have been salvaged in 6 of 7 patients.Transplant patients who present with late urological complications can be challenging. However, the potential for intervention and graft salvage is excellent.

Prospective Randomized Comparison of Urologic Complications in End-to-Side Versus Politano-Leadbetter Ureteroneocystostomy in 131 Human Cadaver Renal Transplants

The incidence of urologic complications was studied in 131 patients with cadaver renal allografts allocated randomly to undergo either the Politano-Leadbetter or end-to-side ureteroneocystostomy. Obstruction occurred in 6 per cent of patients with end-to-side versus 0 per cent of those with Politano-Leadbetter reconstructions (p less than 0.05). Complications of leakage, infection and graft loss were comparable in the 2 groups.