The objective of this study is to evaluate the incidence, diagnosis, management ,surgical technique ,outcome and risk factors of ureteric urologic complications after kidney transplantation. Between 1989-2007, among 1000 kidney transplanted patients, 200 patients were successfully completely followed up for 1-13 years, by clinical examination, graft sonographic study, biochemical and if indicated isotope scanning of the renal graft ( DTPA scanning). All transplanted ureters were stented and received the same immunosuppressive protocol as routine. Those who proved to have ureteral complications were first referred for endourologic intervention , and if failed referred for surgical repair. This study didn`t included extra ureteral obstructive causes, like lymphocele or other pelvic collections. 14 among 200 patients (7%),were developed ureteric complications. M/F ratio =10/4. Ureteral stenosis (6), ureteral fistulae (5) and ureteral obstruction (3). All of them initially treated by percutaneous nephrostomy (PNS) and if were possible antegrade JJ stenting. Those who failed conservative approach, were referred for surgical intervention (10 patients = 3 ureter obstruction + 4 stenosis+ 3 fistulae). (3) cases managed by Boari`s flap, (3) by ureteroureterostomy with native ureter, (3) by pyeloureterostomy with native ureter and (1) by ureteroneocystostomy. One case failed to respond (ureteroureterostomy) and was managed with proper outcome by Boari`s flap. Among 14 patients, 10 were diabetics, 12 had previous history of CMV infection and 5 had acute rejection episodes. In conclusion, post-transplantation ureteral complications are easily diagnosed and can conservatively manage by expert radiologists. Those with prolonged DM, previous acute rejections and / or CMV infection, are better to be referred to surgical repair using native ureters.
Volume : 6
Issue : 4
Pages : 52
Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran