Introduction and Objectives
Urological complications have caused considerable morbidity in kidney transplantation occasionally resulting in graft loss and death. The outcome for transplant recepients has improved due to newer immunosupresive protocols and advancements in surgical techniques. The curent rates of major urological complications in large series are around 6.5%.
Material and Methods
We describe our experience of urological complications in series of 260 live donor kidney transplants, performed in period of 30th Jan 1996. – 27th Jan 2009. The mean age of transplant recepients was 36, and male to female ratio of 2:1. All recepients, except two, underwent extravesical modified Lich Gregoir ureteroneocystostomy (UCN) with two paralel incisions, and all were stented with 6-Fr polyurethane double-J stent. In two patients we performed direct technique of UCN. Tube drains were used routinely and removed when 24-hour drainage was less than 20 ml. The Foley catheter removed between 5–10 days, and the double-J stents after 4 weaks. Graft function was monitored by daily serum biochemestry and urine output. All episodes of urinary leakage, obstruction, stent-related problems and UTI were recorded.
Results
There were 34 complications in 31 patients, an incidence of 13.0%. The incidence of ureter-related major complications rate was 3.5%, the incidence of UTI was 8.9%, retention after remowal of urinarny catheter was noted in 1 (0.4%) patient, and urethral stricture was developed at 1 (0.4%) patient. Urinary leakages occured in 5 cases. In one patient we made revision because of a large urinoma and significant leakage from pyelon. Suture of pyelon was performed. The rest 4 cases were treated conservatively with delayed removal of double-J stent and prolonged bladder catheterisation. Overal 4 patients had hydronephrosis due to extinsinc pressure of the ureter, 2 each due to urinoma and lymphocele. Two patients who had direct UCN developed intrinsinc urteric obstruction ureterovesical anastomosis after removal of double- J stents, with consecutive hydronephrosis. One was treated conservativelly with re-insertion of double-J stent, and the other was reoperated and performed UCN with Boari flap technique. All patients with UTI were treated with culturespecific antibiotics and maintained on prophylactic antibiotics. Urethral stricture at one patient was managed with optical internal urethrotomy and periodic dilatations.
Conclusions
In our series there is a low incidence rate of intrinsinc ureteric obstruction (0.8%) because of routine use of stented extravesical anastomosis by modified Lich Gregoir technique.The rate of intrinsinc ureteric obstruction may be reduced markedly with this technique. Ureteral leakage and extrinsinc compression may occur despate the presence of stents. Early catheter and stent removal does not compromise the anastomosis and may help in reducing the rate of UTI.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
