Urological Complications In Renal Transplantation Research Articles

Урологические осложнения трансплантированной почки.

Introduction. Renal transplantation is the standard of medical care in the treatment of patients with end-stage chronic kidney disease. It increases patient survival in the next five years by 87-93%. Urological complications after transplantation remain one of the main problems – on average they amount to 4-14%. Material and methods. We searched for publications in the PubMed and eLibrary databases using the keywords «kidney transplantation», «urological complications», «post-transplantation period», «urinary leakage», «ureteral stricture», «vesicoureteral reflux». As a result of the search, 57 sources were selected that were used when writing the literature review. Results. By reviewing various studies of complications in the post-transplant period, we identify and characterize the main urological complications of renal transplantation, such as urine leak, hematuria, ureteral stricture, kidney stones and vesicoureteral reflux. The article also reflects the ways of correcting these complications. Conclusions. The analysis showed that proper preoperative urological evaluation of the recipient and correction of urodynamic disorders are crucial to prevent the development of complications; the survival of the transplant directly depends on a multidisciplinary team approach to kidney transplantation and the inclusion of a urologist in the pre- and postoperative monitoring of the patient.

Contemporary management of urological complications in renal transplant: Analysis from a single-center with review of the literature

Context: Urological complications are inevitable in renal transplantation; however, their occurrence and brunt on graft survival can be downsized. The aim of our study was to analyze and review the literature on various urological complications and their management in renal transplant patients. Materials and Methods: We reviewed all cases of urological complications in renal transplantation managed at our institution from January 2010 to March 2017. Results: Urological complications arose in 29 renal transplant patients amidst the study period with median identification time of 24 days (range 0–1500 days). Ten (34.5%) patients developed complications pertaining to ureteric handling and reimplantation followed by significant lymphocele in 9 (31%) patients. Four (13.8%) cases succumbed to vascular anastomosis-related complications. Out of 29 patients, 45% of these complications manifested within a month posttransplant. Complications were tackled individually. Sixteen (55%) cases were treated with either endoscopic or minimally invasive methods, whereas 13 (45%) cases required open surgery. Two grafts were lost as a consequence of vascular complications and a fatality which was directly or indirectly linked with urological complication. Remaining all treated patients improved on follow-up. Conclusion: Comprehensive preoperative recipient evaluation, meticulous organ procurement, and integrated multidisciplinary teamwork are helpful in achieving optimal outcome of transplant. Endourological and minimally invasive procedures are emerging as main modality in the management of these complications; however, many cases still requires contemporary surgical management.

The diagnosis and management of the urological complications of Renal Transplantation: a series of 1100 patients

Objective: To analyse the Urological Complications after Renal Transplantation and their management. Material and methods: -A retrospective analysis of 1150 consecutive live donor renal transplants was performed. The study period extended from December 1995 to December 2004. The surgical procedure for ureteral reimplantation was modified Lich anastomosis. Ultrasonography, renal scanning, antegrade pyelography, retrograde pyelography and cystography were the diagnostic tools. Results: -Overall, 68 primary urological complications (5.9%) were identified during the 15-year experience in 65 patients. The Urological Complications in our series included 35 ureteral obstruction (3.0%), 25 ureteral or bladder leaks (2.17%), 05 out flow obstruction, 02 cases of vesicoureteral reflux and 01 case of ureteral stone. Conclusion: The incidence of Urological Complications in our study is 5.9%. Early exploration of the ureteric leaks and timely intervention to obstructed kidney reduced the morbidity and improves graft su rvival. The causes of these complications and techniques for their prevention are discussed in this study.

The Impact of Insertion of Double J Uretral Stent On Urological Complications in Renal Transplant Recipients: A Single Centre Experience.

Objectives This study aimed to analyze retrospectively the impact of routine Double J stent placement on early urological complications in live related renal transplantation and compared the results with those transplanted without a stent at SIUT. Material and Methods A retrospective study was conducted on 158 patients who underwent live related renal transplantation between December 2007 and May 2008 at SIUT. Based on exclusion criteria 103 patients were selected for the study. These patients were categorized into two groups. Group A comprised of patients who received a Double J stent while group B consisted of patients who were stents free. Early urological complications were recorded. Inclusion criteria were the recipients between 18-50 years, single renal transplants, with normal lower urinary tract and all patients underwent uretrovesical anastomosis by Lich Gregoir technique. The patients with pathological lower urinary tract, having minimum follow-up period of 3 months and those who lost their grafts within this period were excluded. Results: Group A comprised of 54 (52.4%) patients of which 39 were males and 15 females whereas group B had 49 patients (47.6%) of which 41 were males and 8 females. None of the patients in either group developed a urinary leak. In group B, 3 patients developed urinary obstruction while no obstruction was recorded in the Group A (p=0.06). Although 7 patients in group A (12.96%) had a positive urine culture, only 3 patients in Group B developed UTI (p=0.242). Conclusion: This study suggests that routine placement of DJ stent is unnecessary in renal transplant recipients and its use should be limited to patients with an abnormal lower urinary tract.

Management of Urologic Complications in Renal Transplantation: A Single-Center Experience

IntroductionUreterovesical complications subsequent to renal transplantation are associated with a high morbidity leading to graft loss or even death. In the present study, the management of these complications by using interventional and surgical procedures (native pyeloureterostomy [NPUS]/ureteroureterostomy [NUU] vs ureteroneocystostomy [UNC]) was evaluated retrospectively. Patients and MethodsBetween 1994 and 2012, a total of 780 kidney transplantations (690 deceased and 90 living donors) were performed at our institution. Demographic, clinical, and laboratory data from patients with urologic complications were analyzed and compared. ResultsFifty patients (6.4%) exhibited ureterovesical complications, and 18 patients (36%) were operated on immediately. In 32 (64%) of 50 patients, an interventional procedure was initially performed, with 21 patients (66%) undergoing operation due to therapy failure. NPUS/NUU and UNC were performed in 26 (66.6%) and 13 (33.3%) patients, respectively. Indications for an operation were ureteral stenosis in 12 patients (30.8%), ureteral necrosis and urine leakage in 19 patients (48.7%), and symptomatic vesicoureteral reflux in 8 patients (20.5%). Long-term results were comparable between all groups. ConclusionsSurgical revision of ureteral complications should be the standard therapy. NPUS/NUU, UNC, and the successful interventional procedures did not differ significantly in terms of long-term results.

Ureteric Stent in Renal Transplantation

IntroductionSeveral techniques can be used to accomplish the ureteroneocystostomy in kidney transplantation. A ureteral catheter is a prophylactic measure to avoid urological complications (UC) of stenosis and/or fistula. In this study we evaluate the influence of using a ureteral stent upon the rate of UC in renal transplantation. Patients and methodsRetrospective review of 2061 kidney transplants (75 living and 1986 cadaveric donors) for 1360 male and 684 female recipients, from July 14, 1991, to January 13, 2012, with a minimum follow-up of 6 months A double J stent (JJ) was used in 1890 an external tumor (ET) catheter in 52 and no catheter (NC) in 119 cases. ResultsMean recipient age was 44.66 ± 13.66 years. UC occurred in 5.9% among which ET showed 17.3%, 8.4% for NC, and 5.4% for JJ (P < .0005). Urological complications were more frequent when surgery duration exceeded 3 hours (8.8% vs 5.3% ≤ 3 hours; P = .003), using older donors organs (P = .048) and with higher donor weight (P = .009). No differences were observed related to recipient age, gender, or weight; donor gender; pretransplant dialysis time; cold ischemia time; type of donor (living vs cadaveric); number of HLA matches; or initial immunosuppression (mammalian target of rapamycin inhibitor vs other). On multivariate analysis, donor weight (odds ratio [OR]: 1.023; P = .015), use of a JJ vs ET (OR: 0.280; P = .005), and surgery time exceeding 3 hours (OR: 3.270; P < .0005) were independently associated with UC. ConclusionsCatheterization of the urinary anastomosis with a JJ was associated with fewer UC. This is especially important for grafts from heavier donors. The use of an external catheter which was associated with an high rate of UC, should be avoided.

Urologic Complications After Kidney Transplantation: Involvement of the Double-J Stent and the Urologic Suture

Urologic complications in renal transplantation are an important cause of morbidity and hospitalization. This retrospective study of 343 transplants, performed between 1999 and 2009, analyzed the incidence of urinary fistula (4.4%) and ureteral stenosis (3.5%), based upon the type of extravesical anastomosis—Woodruff (W) versus Taguchi (T)—and with versus without the use of a double-J stent. The frequencies of ureteral stenosis with a W anastomosis (without a double J), W + double J, or T + double J were 3.7%, 1.5%, and 9%, respectively ( P = .031). There were differences between W + double J versus T + double J ( P = .015), with a hazard ratio (HR) = 6.3. In relation to a double-J stent, the incidences of fistulae among patients with a double-J stent were: W (12%) versus W + double J (0.8%) versus T + double J (0%; P < .0001; HR = 15.8) versus patients without a double-J stent. Logistic regression showed the predictors of ureteral stenosis to be a urologic anastomosis (odds ratio 0.06, 95% confidence interval [CI]: 0.01–0.49) and delayed renal function (odds ratio 10.1, 95% CI: 1.4–72.4). Concerning fistulae, the best covariates were double-J stent (odds ratio 0.027, 95% CI: 0.003–0.227) and donor age (odds ratio 1.052, 95% CI: 1.01–1.096). A double-J stent protected against the development of a urologic fistula. Donor age was a risk factor. The W suture with a double-J stent was the best way to prevent ureteral stenosis, with delayed graft function being an important risk factor.

A New Technique for Ureteral Defect Lesion Reconstruction Using an Autologous Vein Graft and a Biodegradable Endoluminal Stent

Ureteral defect lesions are severe complications caused by iatrogenic lesions or trauma. For ureteral defect lesions elaborate surgical intervention is needed, such as autotransplantation or ureteral replacement with small bowel. Thus, we developed a new technique for ureteral defect reconstruction in a pig model using an autologous vein graft splinted by an endoluminal biodegradable poly-L-lactic acid stent (Institute of Textile Technology and Process Engineering, Denkendorf, Germany). In 42 pigs we removed the external jugular vein and used it as an autologous vein graft. After median laparotomy a 3 cm segment was resected from the proximal ureter and replaced by the vein with or without an endoluminal biodegradable poly-L-lactic acid stent. As controls, we used 14 pigs. We observed survival, kidney function, and neoureteral and kidney morphological changes for 7 days and for 6 months. After 6 months the stent material was completely broken down and the vein graft was relined with urothelium. It resembled native ureter with cytokeratin-7 positive columnar epithelium and newly formed capillaries in the ureteral wall. All animals had normal kidney function without renal pelvis congestion. This new technique for ureteral defect reconstruction using an autologous vein graft and a biodegradable endoluminal stent is feasible. It is an interesting alternative in the clinic due to the preservation of physiological urine passage and the antireflux mechanism.

Urological Complications: Analysis and Management of 1525 Consecutive Renal Transplantations

Urological complications after renal transplantation increase morbidity, delay graft function, and occasionally lead to graft and/or patient loss. The aim of this study was to analyze the causes of and therapeutic approaches to urological complications in renal transplantation as they related to patient outcomes. A series of 1525 consecutive renal transplantations were performed over a 24-year period. Renal grafts were obtained in 814 cases from living-related and in 711 from cadaveric donors. A Lich-Gregoire ureterovesical reimplantation technique with minimal bladder wall dissection was employed in all cases. Ureteral stents were routinely used in cadaveric transplants and exceptionally among living-related grafts. Urological complications were classified according to the mechanism and site of urinary tract involvement: graft ureteropelvic junction obstruction/stenosis (A), ureteral obstruction/stenosis (B), ureterovesical anastomosis obstruction/stenosis (C), urinary leakage (D), and other (E). Overall, we encountered 96 urological complications (6.3%). Group C complications occurred in 29 cases (30.2%), followed by 27 cases (28.1%) for group B patients, 25 cases (26.0%) for group D, 12 cases (12.5%) for group A, and 3 cases (3.1%) for group E patients. Surgical intervention was required in 49 (51.0%) of all urological complications. The others (n = 47, 49.0%) were treated either conservatively or by minimally invasive procedures. A rapid diagnosis of urological complications, assisted by early posttransplant DTPA scans, routine ultrasonography, and especially prompt treatment, resulted in compensation of renal graft dysfunction in the vast majority (n = 90, 93.8%) of cases. Surgical techniques of graft retrieval and reimplantation are of utmost importance to minimize the incidence of urological complications.

Ureteric Complications of Renal Transplantation: The Impact of the Double J Stent and the Anterior Extravesical Ureteroneocystostomy

The urological complications of renal transplantation are well documented. In 1990, our experience of 507 consecutive renal transplants using the Leadbetter-Politano technique, which was unsplinted in the vast majority of patients, had a ureteric complication rate of 7.7%. Here, we report the long-term incidence and management of our ureteric complications in 1186 consecutive renal transplants done over the following 11 years using an extravesical onlay stented ureteroneocystostomy. We report a considerable reduction in the urological complications of renal transplantation to 3.8%. Furthermore, we were able to use percutaneous radiological techniques to salvage the majority (84.7%) of ureteric complications. Recourse to surgery was required rarely but enabled salvage of all treatment failures.

Urological complications of renal transplantation: a series of 900 cases

Urological complications of renal transplantation: a series of 900 cases

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 in Renal Transplantation: Long-Term Follow-Up of the Woodruff Ureteroneocystostomy Procedure in 433 Patients

Purpose: The two major types of urologic problems after renal transplantation are urinary leakage and obstruction. In this study, we report the urological complications of renal transplantations performed in our hospital during a 22-year period. Patients and Methods: Between 1978 and 2000, 433 consecutive patients underwent renal transplantation. Of those transplants, 50 were cadavers and 383 were living-related donor transplantation. All ureteroneocystostomies were performed with the same technique described by Woodruff. Results: Urological complications developed in 19 (4.23%) recipients. Those complications were urinary leakage in 9 (2%), ureteral obstruction in 9 (2%) and ureteral necrosis in 1 patient (0.23%). All complications occurred during the 6-month postoperative period and after re-operation or conservative management no graft or patient was lost due to urological complications. Conclusion: The quoted overall rate of urological complications varies from 2.9 to 12.5%; our complication rate was 4.23%. This relatively low rate is probably due to the Woodruff ureteroneocystostomy technique.

The efficacy of ureteral stents in prevention of urological complications in renal transplantation

The efficacy of ureteral stents in prevention of urological complications in renal transplantation

EVALUATION OF THE UROLOGICAL COMPLICATIONS OF LIVING RELATED RENAL TRANSPLANTATION AT A SINGLE CENTER DURING THE LAST 10 YEARS: IMPACT OF THE DOUBLE-J STENT

EVALUATION OF THE UROLOGICAL COMPLICATIONS OF LIVING RELATED RENAL TRANSPLANTATION AT A SINGLE CENTER DURING THE LAST 10 YEARS: IMPACT OF THE DOUBLE-J STENT

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.

Urological complications in renal transplantation: impact of a change of technique.

To determine whether the change from the Leadbetter-Politano technique to a stented extravesical technique for the vesico-ureteric anastomosis in renal transplantation has altered the incidence of urological complications. Data were retrieved from a prospective computerized database and by case-note review on 248 consecutive renal transplants performed between January 1990 and June 1996. The characteristics of the donor. recipient and organ were noted, together with the technique used for the vesicoureteric anastomosis and the occurrence of major and minor urological complications. The Leadbetter-Politano technique was used in 140 transplants and the stented extravesical technique in 108. There were no significant differences in the donor, recipient or organ characteristics between the groups. The stented extravesical technique was associated with a significantly lower rate of major complications (< 2%) and clinically significant haematuria than with the Leadbetter-Politano technique. Changing from the Leadbetter-Politano technique to a stented extravesical technique for the vesico-ureteric anastomosis has been a major factor in reducing the incidence of urological complications in our transplant practice.

Urological Complications in Renal Transplantation

Since 1989 the percentage of living-related donor renal transplantations has increased considerably at our institution. We compared the incidence of urological complications in the living-related donor transplantation (LRDT) group and the cadaveric donor transplantation (CDT) group. Between September 1989 and September 1994, 534 consecutive patients underwent a renal transplantation. During that period, the percentage of LRDT increased from 10 to 25 (mean: 14.8) per year. In all patients a transvesical ureteroneocystostomy without antireflux mechanism was performed. A urological complication developed in 64 (11.9%) of the recipients (obstruction in 6.3%; leakage in 5.6%). In 41 (7.7%) patients the complication was transitory and could be managed with minimal invasive measures such as a percutaneous nephrostomy (n = 34), drainage of a paraurethral fluid collection (n = 13), transurethral bladder drainage (n = 3) or a combination of these. In 23 (4.3%) of the recipients a secondary urological intervention such as a pyeloureterostomy (n = 21) or percutaneous dilatation of a ureteral stricture was necessary. The incidence of obstruction was equal in the LRDT and CDT groups, whereas leakage was more frequently encountered in the LRDT group (11.4 vs. 4.6%, p < 0.05). Transplant survival after 1 year was significantly better in the LRDT group than in the CDT group (97 vs. 77%, p < 0.001). The risk of leakage is higher in living-related donor kidney transplantations. Urological complications, however, do not impair graft survival.

Insertion of a Double Pigtail Ureteral Stent for the Prevention of Urological Complications in Renal Transplantation

Insertion of a Double Pigtail Ureteral Stent for the Prevention of Urological Complications in Renal Transplantation

Insertion of a Double Pigtail Ureteral Stent for the Prevention of Urological Complications in Renal Transplantation: A Prospective Randomized Study

Purpose Urologists successfully use ureteral stents to protect the ureterovesical anastomosis in nontransplant patients. Materials and Methods We determined the value of ureteral stents in transplant patients. The frequency of urological complications (leaks, obstructions and urinary tract infections) was compared in a prospective randomized series of 194 kidney transplantations (97 with and 97 without a double pigtail ureteral stent). Results In the stent group 1 patient had a urinary leak and 35 had urinary tract infections (including 2 cases of Corynebacterium cystitis). In the no stent group 6 patients had urinary leaks, 4 had obstructions and 32 had urinary tract infections. The 1-year patient and graft survival rates were similar in both groups, and renal function at 1 year was also similar (229 versus 208 micromole/1. creatinine in the stent and no stent groups, respectively). A small number of stent related complications occurred (2 stent breakages and 1 stent migration). No stones formed in any case. Conclusions Ureteral stent insertion significantly decreases the rate of vesicoureteral leakage and obstruction in renal transplantation.