Ureteral complications following renal transplantation are associated with major morbidity and prolonged hospital stay and frequently require a second surgical procedure. Our purpose was to investigate the incidence, pathogenesis, diagnostic procedures and management of ureteral complications after living unrelated kidney transplantation. To address these topics, we retrospectively analyzed our experience with renal transplantation in this population between January 1991 and January 2007. The median follow-up time was 2.5 (range: 1 to 96) months. Ureteral complications were noted in 29 of the 2609 transplantations including 24 men and 5 women. All of patients received a kidney from living unrelated donors who had undergone transplantation for the first time. The mean age of recipients was 44.8 ± 12.7 (range 18-69) years. The mean body mass index (BMI) was 25.6±5.2 (range: 20.4 - 34.2) kg/m2. Interestingly, the most common cause of end stage renal disease in our patients was hypertension (37.8%), followed by diabetes mellitus (24.1%). None had undergone previous urological surgery. The mean warm and cold ischemic times were 17±2 second and 19±3 minuets, respectively. Twenty of cases only had one complication and 9 had more than one. The overall incidence of ureteral complications among transplant recipients was 1.1 percent; including urinary leakage (82.5%), ureteric strictures (20.7%), uretrovesical junction obstruction (10.3%), early ureteral necrosis (6.9%), ureteropelvic junction obstruction (3.4) and ureteral fistula (3.4%). In most patients with urinary leakage, the problem was improved with insertion of folly catheter. Double-J stent was only required in 2 cases. Six patients (20.7%) with elevated serum creatinine which had ureteral obstruction or stenosis underwent nephrostomy. Surgical site infection was seen in one patient as well as incisional hernia in another case. Although reoperation was required in 5 cases, but renal allograft loss was not seen in our study. Ultrasonography was the most common method used for diagnosis of ureteral complications. Our study showed that uretral complications were rare problems after kidney transplantation. However, early diagnosis and prompt correction are mandatory to prevent graft loss and morbidity of recipient, especially if these complications are associated with infection.
Volume : 6
Issue : 4
Pages : 179
Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran