Introduction and Objectives
Urological complications present a significant cause of morbidity and mortality after kidney transplantation. They often require surgical revision and may lead to a loss of the transplanted kidney. The most frequent place of occurrence of urological complications it the ureter of the transplanted kidney. Complications arise in the case of affection of both the proximal and distal sections of the ureter. During the removal of the kidneys from a dead or living donor, the blood supply of the ureter may be damaged. After kidney transplantation this leads to necrosis of the ureter. Due to a technical mistake, complications may occur at the site of reimplantation of the ureter into the bladder of the recipient or at the place of uretero-ureteral anastomosis, and also a kink of the ureter may occur. Bleeding from the stub of the ureter is another reason of complications. These may be early (until 1 month after kidney transplantation) or late (months or even years after transplantation).
Material and Methods
The authors analyze the reasons of complications related to the ureter of the transplanted kidney. In the group of 131 patients, 135 reconstructions of the lower urinary tract have been performed. In 110 patients the ureter was implanted transvesically using the antireflux technique of Politan and Leadbetter, 22 times the method of direct reimplantation after Boeminghaus in the case of a small and shrunk bladder was used, and twice the reconstruction of the lower urinary tract was performed by side-to-side connection of the ureter of the transplanted kidney with the bladder of the recipient. In three patients the ureter was implanted into an ileal loop after ureteroileostomy. In 120 patients the reconstruction of the lower urinary tract was secured using drainage by an ureteral stent.
Results
The most frequent complication was bleeding from the ureteral stump during the first days after surgery (in 5 women and 4 men). In all patients, this complication was resolved by transureteral fulguration of the bleeding site. In one female patient, a urinary fistula developed with necrosis of the terminal section of the ureter, in one patient the cause of a urinary fistula was unhealed cystotomy. Stenoses of the distal ureter were observed in 4 patients (3 women and 1 man). In 5 patients (2 women and 3 men) we diagnosed a kinked ureter as the cause of insufficient drainage of the transplanted kidney. All complications resulting from pathology of the ureter of the transplanted kidney were successfully resolved surgically. In 2 patients we replaced the ureter of the transplanted kidney by a segment of ileum.
Conclusions
Temporary drainage of the ureter by an ureteral stent proved to be the only explanation for the marked decrease of severe urological complications (urinary fistulas and obstruction, particularly in the early stage after kidney transplantation) in comparison with previous data recorded in our centre, when endoprostheses were not used.
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© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
