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Sarier M, Yayar O, Yavuz A, Turgut H, Kukul E. Update on the Management of Urological Problems Following Kidney Transplantation. Urol Int 2021; 105:541-547. [PMID: 33508852 DOI: 10.1159/000512885] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
Urological problems in kidney transplant recipients are not limited only to posttransplantation urological complications. These problems are a cause of significant patient mortality and morbidity that have wide-ranging effects on graft survival throughout the entire life of the graft. Ultimately, the transplant comprises a major portion of the urinary system; therefore, the transplant team should be prepared for foreseeable and unforeseeable urological problems in the short and long terms. These mainly include postoperative urological complications (urine leakage, ureteral stenosis, and vesicoureteral reflux), bladder outlet obstruction, and graft urolithiasis. In recent years, significant advances have been made in the management of urological complications, especially due to advances in endourologic interventions. The aim of this review is to summarize the management of urological problems after kidney transplantation in the context of the current literature.
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Affiliation(s)
- Mehmet Sarier
- Department of Urology, Istinye University, Istanbul, Turkey,
| | - Ozlem Yayar
- Department of Nephrology, Medical Park Hospital, Antalya, Turkey
| | - Asuman Yavuz
- Department of Nephrology, Medical Park Hospital, Antalya, Turkey
| | - Hasan Turgut
- Faculty of Health Science, Avrasya University, Trabzon, Turkey
| | - Erdal Kukul
- Department of Urology, Medical Park Hospital, Antalya, Turkey
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Salter S, Lee A, Jaya J, Suh N, Yii MK, Saunder A. Timely surgical intervention for ureteric complications ensures adequate graft function in renal transplantation: a 10-year review. ANZ J Surg 2020; 90:1340-1346. [PMID: 32384207 DOI: 10.1111/ans.15914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ureteric complications can cause significant morbidity in renal and simultaneous pancreas-kidney (SPK) transplantation. This 10-year review identified transplant patients with ureteric complications necessitating surgical intervention in an Australian tertiary centre. METHODS The hospital records were scrutinized in detail to identify all patients who underwent renal or SPK transplantation from 1 June 2009 to 31 May 2019 with subsequent surgical management of ureteric complications. A case series of patients with ureteric complications was generated and findings were analysed. RESULTS A total of 893 renal and SPK transplants were performed over the 10-year period. Ten of these (1.12%; seven renal and three SPK) had ureteric complications. All were managed surgically. Five of the 10 had ureteric leaks (0.56%); three had ureteric strictures (0.34%), one had ureteric obstruction from extraluminal compression (0.11%) and one had both leak and stricture (0.11%). All 10 patients underwent ureteric reimplantation. Two patients required more than one operation for their ureteric complication. No graft loss or surgical mortality occurred. All 10 patients currently have functioning kidney transplants and none require maintenance dialysis. CONCLUSION We report a low rate (1.12%) of ureteric complications in our renal and SPK transplants. Our standard practice of definitive correction by ureteric reimplantation is proving successful. The authors confirm that appropriate surgery is a viable and durable option in renal transplant patients with excellent graft outcomes.
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Affiliation(s)
- Sherry Salter
- Department of Vascular and Transplantation Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Alice Lee
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Joseph Jaya
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Nancy Suh
- Department of Vascular and Transplantation Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Nephrology Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ming Kon Yii
- Department of Vascular and Transplantation Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, School of Clinical Sciences at Monash Health, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Alan Saunder
- Department of Vascular and Transplantation Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, School of Clinical Sciences at Monash Health, Monash Medical Centre, Melbourne, Victoria, Australia
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[Results of surgical revisions for ureteral complications after renal transplantation]. Prog Urol 2019; 29:474-481. [PMID: 31400962 DOI: 10.1016/j.purol.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/25/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze the results of surgical revision for ureteral complication (ureteric stenosis or urinary leakage) after renal transplantation over a period of 10 years. MATERIALS AND METHODS We performed a retrospective study on 1313 consecutive kidney transplantations carried out in a University Hospital Center between 2005 and 2014. The data of the patients who developed a ureteral stenosis or a urinary leakage secondary to a renal transplantation were analyzed. Combined organ transplantations (kidney-liver and kidney-pancreas), as well as pediatric transplantations were excluded. RESULTS Seventy-six patients (5.8%) had ureteric stenosis or urinary leakage after renal transplantation. Forty-six patients (3.5%) underwent surgical revision: 27 for ureteral stenosis, 19 for urinary leakage. Early success was achieved in 26 patients (56.5%), including 14 ureteric stenosis (51.9%) and 12 urinary leakage (63.2%) (P=0.45). After a complementary endoscopic or surgical treatment, the final success rate was increased to 73.1% (34 patients): 20 ureteric stenosis (74.1%) and 14 urinary leakage (73.7%) (P=0.98). There were 2 graft losses (4.3%) and one death (2.2%). The mean glomerular filtration rate estimated by the MDRD was 44.58mL/min/1.73m2 (±14.7) before surgery and 45.37mL/min/1.73m2 (±16.5) 6 months after surgery (P=0.92). CONCLUSION Although frequently challenging, surgical revisions for ureteral complications after renal transplantation give good results, with a low rate of graft loss and mortality. LEVEL OF EVIDENCE 4.
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Kusuma Duarsa GW, Gede Oka AA, Santosa KB, Yudiana IW, Wisnu Tirtayasa PM, Putra Pramana IB, Kloping YP. Successful Boari Flap ureteroneocystostomy for distal ureteral necrosis after renal transplantation. Urol Case Rep 2019; 23:48-49. [PMID: 30581754 PMCID: PMC6301971 DOI: 10.1016/j.eucr.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
- Corresponding author. Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Diponegoro Street, Denpasar, Bali, 80113, Indonesia.
| | - Anak Agung Gede Oka
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - Kadek Budi Santosa
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - I. Wayan Yudiana
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - Pande Made Wisnu Tirtayasa
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - Ida Bagus Putra Pramana
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
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Guerrero-Ramos F, Cavero-Escribano T, Rodríguez-Antolín A, Andrés-Belmonte A, Passas-Martínez J, Tejido-Sánchez Á. Perigraft fluid collections after kidney transplantation: Does the type of donor (uncontrolled donation after circulatory death vs. donation after brain death) have a role? Cent European J Urol 2018; 70:439-444. [PMID: 29410900 PMCID: PMC5791392 DOI: 10.5173/ceju.2017.1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/28/2017] [Accepted: 09/18/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Perigraft fluid collection (PFC) is a common complication after kidney transplant. Its etiology is not clear and not all the causes have been identified. The influence of the type of donor has never been evaluated. Our aim was to compare the incidence, severity and management of PFC in recipients of grafts from uncontrolled donors after circulatory death (DCD) with normothermic extracorporeal membrane oxygenation (NECMO) versus recipients of grafts from donors after brain death (DBD). Material and methods We conducted a retrospective cohort study of 300 kidney transplants performed in our center between 2007 and 2012. Patients were divided in two groups: 150 recipients of Maastricht II DCD graft and 150 recipients of the DBD graft. Incidence, severity according to Clavien scale and management were analyzed in both groups, and comparison was carried out using Chi-square. Results Of the 300 kidney recipients analyzed, 93 (31.4%) suffered PFC, showing no difference between DBD (32.0%) and DCD (30.8%) groups (p = 0.9). Complicated PFC rate (defined as a PFC generating vascular compression, fever or urinary tract obstruction) was 22.9% in the DBD group versus 22.2% in the DCD group (p = 1); most complicated PFC were due to urinary tract obstruction (81%), with no difference between the groups (p = 1). Concerning Clavien scale, 78.5% of the PFC in our series were Clavien I, 19.4% Clavien IIIa and 2.2% Clavien IIIb, with no difference between both groups (p = 1). Conclusions PFC is a frequent complication that appears in a third of our patients, showing no difference in the incidence or severity between DBD and uncontrolled DCD graft recipients.
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Outcomes of Kidney Transplant Recipients With Percutaneous Ureteral Interventions: A Single-Center Study. Transplant Direct 2016; 3:e123. [PMID: 28349123 PMCID: PMC5361563 DOI: 10.1097/txd.0000000000000637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/02/2016] [Indexed: 01/21/2023] Open
Abstract
Background Long-term outcomes of kidney transplantation recipients with percutaneous ureteral management of transplant ureteral complications are not well characterized. Methods Electronic records of 1753 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. One hundred thirty-one patients were identified to have undergone percutaneous ureteral management, with placement of percutaneous nephrostomy tube or additional intervention (nephroureteral stenting and/or balloon dilation). Indications for intervention included transplant ureteral stricture or ureteral leak. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes. Results Kaplan- Meier graft survival (P = 0.04) was lower in patients with percutaneous ureteral intervention for transplant ureteral complication. Graft survival at 1, 5, and 10 years was 94.3% 78.3%, and 59.1% for no intervention and 97.2%, 72.1%, and 36.2% for intervention cohort. Patient survival (P = 0.69) was similar between cohorts. Multivariate analysis demonstrated no association with graft failure (hazard ratio, 1.21; 95% confidence interval, 0.67-2.19; P = 0.53) or patient death (hazard ratio, 0.56; 95% confidence interval, 0.22-1.41; P = 0.22) in intervention group. The major cause of graft failure was infection for percutaneous ureteral intervention group (20.4%) and chronic rejection for those without intervention (17.3%). Conclusions Kidney transplant recipients with percutaneous ureteral interventions for ureteral complications do not have a significant difference in graft and patient survival outcomes. Therefore, aggressive nonoperative management can be confidently pursued in the appropriate clinical setting.
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Kolli KP, LaBerge JM. Interventional Management of Nonvascular Renal Transplant Complications. Tech Vasc Interv Radiol 2016; 19:218-27. [DOI: 10.1053/j.tvir.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Pabon-Ramos WM, Dariushnia SR, Walker TG, Janne d’Othée B, Ganguli S, Midia M, Siddiqi N, Kalva SP, Nikolic B. Quality Improvement Guidelines for Percutaneous Nephrostomy. J Vasc Interv Radiol 2016; 27:410-4. [DOI: 10.1016/j.jvir.2015.11.045] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022] Open
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Massive hemorrhage due to external iliac artery laceration in kidney transplantation: A case report of an uncommon complication after CT guided drainage. INDIAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.1016/j.ijt.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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