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Sabnis RB, Singh AG, Ganpule AP, Chhabra JS, Tak GR, Shah JH. The development and current status of minimally invasive surgery to manage urological complications after renal transplantation. Indian J Urol 2016; 32:186-91. [PMID: 27555675 PMCID: PMC4970388 DOI: 10.4103/0970-1591.185100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Introduction: In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques. Materials and Methods: A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed. Results: The incidence of urological complications postrenal transplantation was reported to be 2–13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50–70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients. Conclusion: Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy.
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Affiliation(s)
- Ravindra B Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhishek G Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Jaspreet S Chhabra
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Gopal R Tak
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Jaimin H Shah
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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A case of continuous negative pressure wound therapy for abdominal infected lymphocele after kidney transplantation. Case Rep Transplant 2014; 2014:742161. [PMID: 25374744 PMCID: PMC4206933 DOI: 10.1155/2014/742161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Lymphocele is a common complication after kidney transplantation. Although superinfection is a rare event, it generates a difficult management problem; generally, open surgical drainage is the preferred method of treatment but it may lead to complicated postoperative course and prolonged healing time. Negative pressure wound therapy showed promising outcomes in various surgical disciplines and settings. We present a case of an abdominal infected lymphocele after kidney transplantation managed with open surgery and negative pressure wound therapy.
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Riediger C, Müller MW, Bachmann J, Novotny A, Thorban S, Matevossian E, Friess H, Stangl M. Native ureteropyelostomy: an effective therapy for urinary tract complications following kidney transplantation. ANZ J Surg 2014; 84:643-8. [DOI: 10.1111/ans.12526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Carina Riediger
- Department of Surgery; Technische Universität München; Munich Germany
| | - Michael W. Müller
- Department of Surgery; Technische Universität München; Munich Germany
- Department of Surgery; Klinikum Stuttgart, Clinical Center Bad Cannstatt; Stuttgart Germany
| | - Jeannine Bachmann
- Department of Surgery; Technische Universität München; Munich Germany
| | - Alexander Novotny
- Department of Surgery; Technische Universität München; Munich Germany
| | - Stefan Thorban
- Department of Surgery; Technische Universität München; Munich Germany
| | | | - Helmut Friess
- Department of Surgery; Technische Universität München; Munich Germany
| | - Manfred Stangl
- Department of Surgery; Technische Universität München; Munich Germany
- Department of Surgery; Ludwig Maximilian's University; Munich Germany
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Ali-Asgari M, Dadkhah F, Ghadian A, Nourbala MH. Impact of ureteral length on urological complications and patient survival after kidney transplantation. Nephrourol Mon 2013; 5:878-83. [PMID: 24350086 PMCID: PMC3842558 DOI: 10.5812/numonthly.10881] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/10/2013] [Accepted: 05/06/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urologic complications are of the most important complications after kidney transplantation which increases mortality and morbidity significantly. OBJECTIVES We designed this study to evaluate the association between ureteral length and postoperative complications. PATIENTS AND METHODS We recorded the length of the transplanted ureter during the operation. Ureter-to-bladder anastomosis was performed using modified Lich-Gregoir method on the ureteral stent. Complications like urine leakage and increased creatinine were evaluated. We used both univariate and multivariate analyses and survival analysis according lengths of ureter. It means that the main variable is ureteral length and other variables are studied based on it. RESULT A total of 395 patients with the mean age of 37 years (range, 18 to 68 years) were enrolled in the study, twenty six graft lost during the follow-up period. The Mean age of recipients was 37 ± 13 years. Urinary stenosis was seen in 6 patients (1.5%) and urinary leakage in 4 (1%) patients. The complication rate was not significantly different between these groups (P = 0.67). We found that there were no significant difference among complication (P = 0.25), hospitalization (P = 0.31) and survival (P = 0.84) at 5.5 cm length cut off. CONCLUSIONS The length of transplanted ureter does not affect the postoperative urologic complications (including urinary fistula and ureter-to-bladder anastomosis stricture), and it seems that decreased rate of complication frequency during the recent years is due to technical improvement, surgeon's skillfulness and development in use of immunosuppressant's postoperatively.
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Affiliation(s)
- Majid Ali-Asgari
- Department of Urology, Shaheed Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Farid Dadkhah
- Department of Urology, Shaheed Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Alireza Ghadian
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Alireza Ghadian, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-9123197306, E-mail:
| | - Mohammad Hossein Nourbala
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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5
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Saidi RF, Elias N, Hertl M, Kawai T, Cosimi AB, Ko DS. Urinary reconstruction after kidney transplantation: Pyeloureterostomy or ureteroneocystostomy. J Surg Res 2013; 181:156-9. [DOI: 10.1016/j.jss.2012.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/27/2012] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
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6
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Gowda BD, Goldsmith P, Ahmad N. Boari flap vesicocalycostomy: a salvage drainage procedure for complete ureteric stricture and pyelocalyceal fistula. Clin Transplant 2009; 23:129-31. [DOI: 10.1111/j.1399-0012.2008.00907.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garat JM, Caffaratti J, Angerri O, Bujons A, Villavicencio H. Kidney transplants in patients with bladder augmentation: correlation and evolution. Int Urol Nephrol 2007; 41:1-5. [PMID: 17211571 DOI: 10.1007/s11255-006-9164-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 11/29/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the literature, analyse the evolution of kidney transplants (KT) in patients with bladder augmentation (BA) and investigate the relation between BA and KT. MATERIALS AND METHODS Six patients with a history of severe lower urinary tract dysfunction and BA, received a KT at our Unit between 1993 and 2003. Three had moderate renal failure at the moment of the BA. The remaining three had end stage renal failure. RESULTS With a follow-up of 7 years (mean) we have a patient survival of 100% and a graft survival of 83%. No complications occurred between the BA and the KT. The few KT complications were not related to BA. CONCLUSION When a bladder dysfunction is present, it should be treated before KT. In noncompliant bladders, BA is the best treatment. This can be done to try to avoid end stage renal failure or only to prepare the lower urinary tract for reception of the transplant. The presence of a BA did not worsen the evolution of the KT.
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Affiliation(s)
- Jose Maria Garat
- Urology, Fundacio Puigvert, Cartagena, 340-350, Barcelona 08025, Spain.
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8
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Gurkan A, Yakupoglu YK, Dinckan A, Erdogdu T, Tuncer M, Erdoğan O, Demirbas A, Akaydin M. Comparing two ureter reimplantation techniques in kidney transplant recipients. Transpl Int 2006; 19:802-6. [PMID: 16961771 DOI: 10.1111/j.1432-2277.2006.00348.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We compared the incidence of urological and anastomotic complications for the ureteroureterostomy and Lich-Gregoir techniques in kidney transplant recipients. Between May 2003 and February 2004, 75 kidney transplant recipients from living donors were divided into two similar groups to receive ureteroureterostomy (n = 41, 28 male, 13 female) and Lich-Gregoir techniques (n = 34, 24 male, 10 female) for ureteral reimplantation. Patients with vesicoureteral reflux (VUR) to the native kidneys were excluded from the study. The urological complications included complicated hematuria, ureteral stenosis, symptomatic VUR, recurrent urinary tract infection (UTI). There was no statistical significance between two groups in terms of gender, age, end-stage renal disease etiology, human leucocyte antigen (HLA) mismatch numbers, type and duration of dialysis, and cold ischemia time. The incidence of urologic and anastomotic complications was 12%. Complications in the Lich-Gregoir group included symptomatic VUR in 8.8% and stent migration in 2.9% of cases. Complications observed in the ureteroureterostomy group were ureteral stricture 7.3% and complicated hematuria in 4.9% of cases. However, symptomatic reflux was not observed in the ureteroureterostomy group. UTI frequency was similar in both groups. Ureteroureterostomy can be safely performed as a primary choice in kidney transplant recipients.
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Affiliation(s)
- Alihan Gurkan
- Department of General Surgery, Akdeniz University Transplantation Center, Antalya 07059, Turkey.
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9
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Guleria S, Mehta SN, Mandal S, Aggarwal S, Gupta S, Bhowmik D, Aggarwal SK, Tiwari SC. Povidone-iodine in the treatment of lymphatic fistulae in renal transplant recipients. Transplant Proc 2003; 35:327-8. [PMID: 12591425 DOI: 10.1016/s0041-1345(02)03772-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Guleria
- Department of Surgery and Nephrology, All India Institute of Medical Sciences, New Delhi, India
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URETERONEOCYSTOSTOMY CONTRIBUTES TO LATE FUNCTIONAL AND MORPHOLOGICAL CHANGES IN RAT KIDNEY TRANSPLANTS. J Urol 2001. [DOI: 10.1097/00005392-200105000-00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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URETERONEOCYSTOSTOMY CONTRIBUTES TO LATE FUNCTIONAL AND MORPHOLOGICAL CHANGES IN RAT KIDNEY TRANSPLANTS. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66397-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Hussain M, Khalique M, Askari H, Lal M, Hashmi A, Hussain Z, Naqvi A, Rizvi A. Surgical complications after renal transplantation in a living-related transplantation program at SIUT. Transplant Proc 1999; 31:3211. [PMID: 10616445 DOI: 10.1016/s0041-1345(99)00694-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Hussain
- Sindh Institute of Urology and Transplantation (SIUT), Dow Medical College, Karachi, Pakistan
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13
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Affiliation(s)
- M Samhan
- Hamed Al-Essa Organ Transplantation Centre, Ibn Sina Hospital, Hawally, Kuwait
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14
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Kimikawa M, Sachs DH, Colvin RB, Bartholomew A, Kawai T, Cosimi AB. Modifications of the conditioning regimen for achieving mixed chimerism and donor-specific tolerance in cynomolgus monkeys. Transplantation 1997; 64:709-16. [PMID: 9311707 DOI: 10.1097/00007890-199709150-00008] [Citation(s) in RCA: 164] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We demonstrated previously that a nonmyeloablative preparative regimen can induce mixed chimerism and allograft tolerance in cynomolgus monkeys. METHODS The current studies were designed to clarify the importance and toxicity of various elements of the allotolerance conditioning regimen by: fractionating or reducing the whole-body irradiation (WBI) dosage; adding deoxyspergualine; or deleting donor bone marrow, cyclosporine, irradiation, or splenectomy. RESULTS Monkeys treated without donor bone marrow, cyclosporine, or irradiation did not develop chimerism or long-term allograft survival. One of three monkeys treated without splenectomy developed chimerism but died of a surgical complication. The other two did not develop chimerism and rejected by day 117. Six of six monkeys treated with 300 cGy of fractionated WBI developed chimerism. Five of these recipients had long-term graft survival. Only two of four monkeys treated with 250 cGy developed chimerism, so a 2-week course of deoxyspergualine was added. This led to chimerism in two monkeys, but one died of ureteral stenosis and the other died of allograft rejection. An unanticipated high incidence of ureteral complications felt to be secondary to rejection episodes and ischemic injury was observed in the long-term surviving animals. CONCLUSIONS All parameters of the original preparative regimen seem to be essential for consistent success. The degree of lymphocyte depletion was proportional to the WBI dose. Long-term graft survival was observed only in recipients achieving lymphocyte chimerism of > 1.5%. In this model, lymphocyte depletion seems to be the best predictor of chimerism, and significant lymphocyte chimerism seems to be important in achieving tolerance.
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Affiliation(s)
- M Kimikawa
- Transplantation Unit, Massachusetts General Hospital, Boston 02114, USA
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15
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Maier U, Madersbacher S, Banyai-Falger S, Susani M, Grzünberger T. Late ureteral obstruction after kidney transplantation. Transpl Int 1997. [DOI: 10.1111/j.1432-2277.1997.tb00539.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Maier U, Madersbacher S, Banyai-Falger S, Susani M, Grünberger T. Late ureteral obstruction after kidney transplantation. Fibrotic answer to previous rejection? Transpl Int 1996; 10:65-8. [PMID: 9002155 DOI: 10.1007/bf02044345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Today, the incidence of urological complications following renal transplantation is 2%-10%. Most of these complications occur within the 1st year and affect the distal ureter. We report on two patients who developed very late ureteral obstruction, 14 and 18 years after transplantation. Both patients had rejection episodes 1 and 10 months prior to the ureteral stenosis. Histological examination of one resected ureter revealed findings strongly suggestive of a rejection process. Open surgery with antirefluxive reimplantation into the bladder was successful in both patients, with a postoperative observation time of 20 and 8 months, respectively. We conclude that a percutaneous nephrostomy may be required in patients with rising creatinine and incipient hydronephrosis even long after transplantation has been performed.
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Affiliation(s)
- U Maier
- Department of Urology, University of Vienna, Austria
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17
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Insall RL, Bell R, Hutchison BG, Haywood EF, House AK. A method for the treatment of ureteric complications following renal transplantation. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1995; 65:654-7. [PMID: 7575297 DOI: 10.1111/j.1445-2197.1995.tb00675.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Over an 8-year period, 117 renal transplants (97 cadaveric and 20 living related) were performed at the Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Ureteric complications following renal transplantation occurred following seven transplants (6%). The technique of using a multiply fenestrated vesicocutaneous stent/drain to manage this problem is described. This was uncomplicated in all cases with the exception of one case in which the stent/drain was removed early because of blockage and sepsis, but most importantly on no occasion was the graft lost. We therefore recommend this technique for the management of this complication, whether early or late. We observed a disproportionate number of ureteric complications in living related transplants, a feature not described previously.
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Affiliation(s)
- R L Insall
- Department of Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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18
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Heron SP, O'Brien DP, Whelchel JD, Neylan JF. Ureteral Obstruction Due to Calculi in the Early Postoperative Period in Renal Cadaveric Transplantation: A Case Report and Discussion of Ureteral Obstruction in the Renal Transplant Patient. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67555-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sean P. Heron
- Division of Urology, Department of Surgery and Division of Nephrology, Department of Medicine, The Emory University School of Medicine, Atlanta, Georgia
| | - David P. O'Brien
- Division of Urology, Department of Surgery and Division of Nephrology, Department of Medicine, The Emory University School of Medicine, Atlanta, Georgia
| | - John D. Whelchel
- Division of Urology, Department of Surgery and Division of Nephrology, Department of Medicine, The Emory University School of Medicine, Atlanta, Georgia
| | - John F. Neylan
- Division of Urology, Department of Surgery and Division of Nephrology, Department of Medicine, The Emory University School of Medicine, Atlanta, Georgia
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Wagner M, Dieckmann KP, Klän R, Fielder U, Offermann G. Rescue of renal transplants with distal ureteral complications by pyelo-pyelostomy. J Urol 1994; 151:578-81. [PMID: 8308961 DOI: 10.1016/s0022-5347(17)35019-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Secondary ureteroneocystostomy is the procedure most commonly used for repair of ureteral stenosis or necrosis in renal transplant patients. However, when the transplant ureter available for reconstruction is too short, ureteropyelostomy is the standard procedure. Another option is pyelo-pyelostomy, which has been used infrequently to date. Between 1979 and 1988 we managed 6 patients (4 men and 2 women 42 to 62 years old) with renal allografts who required repair of the transplant ureter for long segmented ureteral necrosis (3), long segmented ureteral stenosis (2) and an iatrogenic lesion of the ureter (1) with pyelo-pyelostomy. Of the 6 patients 2 had undergone previous rescue operations. Pyelo-pyelostomy with the renal pelvis of the graft was performed as first described by Gil-Vernet and Caralps in 1968. Median followup was 6 years (range 3 to 12 years). Two patients died of chronic rejection and pulmonary embolism, respectively. Four patients are still alive with functioning transplants and serum creatinine levels of less than 210 mumol/l. According to our experiences with 6 patients, we believe that pyelo-pyelostomy is a promising rescue maneuver that is worth consideration in cases of total or subtotal ureteral necrosis and long segmented ureteral stenosis after renal transplantation.
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Affiliation(s)
- M Wagner
- Urologische Klinik, Klinikum Steglitz, Freie Universität Berlin, Germany
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Petritsch PH, Vilits P, Rauchenwald M, Colombo T, Breinl E, Hechtl W, Altziebler S, Pummer K, Holzer H. Nierentransplantation. ACTA ACUST UNITED AC 1994. [DOI: 10.1007/bf02619722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Swierzewski SJ, Konnak JW, Ellis JH. Treatment of renal transplant ureteral complications by percutaneous techniques. J Urol 1993; 149:986-7. [PMID: 8483250 DOI: 10.1016/s0022-5347(17)36274-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
From January 1985 to October 1990, 487 adult renal transplantations were performed at our institution. Of 16 ureteral complications noted 15 were initially managed with percutaneous nephrostomy. Of the 8 complications that occurred during the last 2 years 5 resolved on percutaneous nephrostomy and stenting, or stenting with dilation alone. We conclude that percutaneous nephrostomy is indicated as an initial step in the diagnosis and treatment of urological transplant complications, and that it allows for nonoperative resolution of many of these complications.
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Affiliation(s)
- S J Swierzewski
- Department of Surgery (Section of Urology), University of Michigan Hospitals, Ann Arbor
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24
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Thomalla JV, Leapman SB, Filo RS. The use of internalised ureteric stents in renal transplant recipients. BRITISH JOURNAL OF UROLOGY 1990; 66:363-8. [PMID: 2224430 DOI: 10.1111/j.1464-410x.1990.tb14955.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Since 1982, we have used internal indwelling ureteric stents for the management and prevention of ureteric reconstruction complications in 28 renal allograft recipients. A total of 30 stents were placed in 18 patients either diagnostically or therapeutically in the management of allograft ureteric obstruction. In 16 patients internal stents were placed at the time of reconstruction for primary ureteropyelostomy (3), secondary ureteropyelostomy (8), repeat reimplant (3) and repair of ureteric or pelviureteric junction injury (2). Complications included 3 episodes of transplant pyelonephritis, proximal stent migration (1), persistent bacteriuria (1) and prolonged healing of a ureteropyelostomy (1). Internalised ureteric stenting is a safe and effective means of managing or preventing ureteric reconstruction complications in renal transplant recipients.
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Affiliation(s)
- J V Thomalla
- Department of Surgery, Indiana University Medical Center, Indianapolis
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Affiliation(s)
- Y Reinberg
- Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis
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Alpenländisch-adriatisches Symposium für internationale zusammenarbeit in der rehabilitation. Eur Surg 1989. [DOI: 10.1007/bf02656242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Streem SB, Novick AC, Steinmuller DR, Zelch MG, Risius B, Geisinger MA. Long-term efficacy of ureteral dilation for transplant ureteral stenosis. J Urol 1988; 140:32-5. [PMID: 3288774 DOI: 10.1016/s0022-5347(17)41477-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Transluminal ureteral dilation was performed in 11 renal allograft recipients with transplant ureteral obstruction. Success was achieved in 5 patients (45 per cent) with a followup of 12 to 29 months (mean 19.6 months). All failures have been evident within 12 months of dilation. We conclude that ureteral dilation can provide long-term success in renal allograft recipients. However, continued close long-term monitoring of the anatomical and functional result is mandatory for patients treated in this manner.
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Affiliation(s)
- S B Streem
- Section of Endourology, Cleveland Clinic Foundation, Ohio 44106
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Hickey DP, Glacken P, Gawley W, Carey J, Mulcahy M, McLean PA Hanson JS, Hanson JS, Murphy DM. Urological complications in 454 renal transplants. Ir J Med Sci 1988; 157:222-5. [PMID: 3049435 DOI: 10.1007/bf02949305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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