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Renal transplantation is the current standard treatment for end-stage renal disease and is associated with immunologic, vascular, and urologic complications. In this study we report urologic complications following ureteral reimplantation based on 1 urologist's experience at a single high-volume renal transplant institution., Methods: A retrospective review was performed on all patients who underwent ureteral reimplantation by the transplant urologist at the time of their kidney transplant between July 1, 1993, and December 31, 2016., Results: There was a total of 3951 ureteral reimplantations performed for 3890 renal transplants. The overall complication rate was 7% (276 patients). Vesicoureteral reflux was the most common complication (4.25%), followed by ureteral stricture (1.9%), urine leak (0.6%), and de novo ureteropelvic junction obstruction (0.25%)., Conclusion: This study is a continuation of our previous case series. Over time, our overall rate of urologic complications has increased. Vesicoureteral reflux has remained the most common complication with increasing incidence compared with our prior reviews. One possible cause for increased incidence is our thorough longitudinal follow-up over more than 2 decades. Some patients who previously had no evidence of reflux eventually did in fact develop reflux. The incidence of ureteral stricture, urine leak, and ureteropelvic junction obstruction has overall remained stable over the past 23 years. In our program, 1 transplant urologist has performed almost all ureteroneocystostomies, leading to consistent management and generalizable results. Review of the literature shows variable rates of complications among different studies with multiple surgeons, disparate techniques, and short follow-up. Our study eliminates many of these confounding factors and provides more reliable, reproducible data., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Only surgically irrelevant risk factors including sex, African-American ancestry, or exceptional U-stitch anastomosis have been identified to associate with urinary complications after kidney transplantation. The objective was to identify modifiable and nonmodifiable risk factors associated with urinary complications after kidney transplantation., Methods: A single-center study of 3,129 kidney transplants performed over 40 years was conducted to identify independent risk factors using χ 2 tests and logistic regression analysis., Results: We identified the quality of the transplant's ureter, cystographic abnormalities in the recipient, and repeat transplantations as independent risk factors for overall urinary complications occurring after kidney transplantation in multivariable analysis. Obesity was associated with an increased risk of urinary fistula, while the presence of a JJ stent was associated with a reduced risk of urinary fistula. The risk of urinary surgical complications for kidney transplantations was reduced when the kidney was recovered from a living related compared to a deceased donor., Conclusions: The risk factors identified in the present study will allow candidates for kidney transplantation to be more informed and will also allow for surgical modifications to limit the occurrence of urinary complications., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: We report the incidence and nature of ureteral and surgical complications in our series of 853 consecutive living-donor renal transplants after laparoscopic living-donor nephrectomy. The aim of this study was to analyze the therapeutic approaches to ureteral complications in kidney transplantations and their relationship with recipient outcome., Methods: The medical records of patients who underwent kidney transplantation from 2000 to 2014 were reviewed retrospectively. After the donor nephrectomies were performed with the use of laparoscopic, hand-assisted laparoscopic, and vesico-ureteral anastomosis, the recipient's ureteral complications were classified according to the mechanism and site of urinary tract involvement: anastomosis stricture, anastomosis leakage, vesico-ureteral reflux, and urolithiasis., Results: Among the 853 cases of kidney transplantation, ureteral complications occurred in 66 patients (7.73%). The most common complication was urinary tract infection caused by vesico-ureteral reflux (n = 24, 2.81%), which was managed with by means of sub-ureteral polydimethylsiloxane injection. The second most common complication was the anastomosis site stricture (n = 23, 2.69%), which was treated by means of ureteral re-implantation or percutaneous nephrostomy. Anastomosis site leakage occurred in 11 patients (1.28%) and was managed by percutaneous nephrostomy with double-J stenting and drainage or ureteral re-implantation. Urolithiasis occurred in 8 patients (0.93%)., Conclusions: There was an 8% rate of recipient ureteral complications at our institution. Of the 66 patients, 46 (5.4%) required surgical repair. The remaining 20 patients with ureteral complications were treated with conservative care or minimally invasive procedures. The keys to successful management of these problems are early diagnosis and prompt reconstruction whenever possible. Most ureteral complications are easily managed with a successful outcome with early intervention., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Ureterovesical complications subsequent to renal transplantation are associated with a high morbidity leading to graft loss or even death. In the present study, the management of these complications by using interventional and surgical procedures (native pyeloureterostomy [NPUS]/ureteroureterostomy [NUU] vs ureteroneocystostomy [UNC]) was evaluated retrospectively., Patients and Methods: Between 1994 and 2012, a total of 780 kidney transplantations (690 deceased and 90 living donors) were performed at our institution. Demographic, clinical, and laboratory data from patients with urologic complications were analyzed and compared., Results: Fifty patients (6.4%) exhibited ureterovesical complications, and 18 patients (36%) were operated on immediately. In 32 (64%) of 50 patients, an interventional procedure was initially performed, with 21 patients (66%) undergoing operation due to therapy failure. NPUS/NUU and UNC were performed in 26 (66.6%) and 13 (33.3%) patients, respectively. Indications for an operation were ureteral stenosis in 12 patients (30.8%), ureteral necrosis and urine leakage in 19 patients (48.7%), and symptomatic vesicoureteral reflux in 8 patients (20.5%). Long-term results were comparable between all groups., Conclusions: Surgical revision of ureteral complications should be the standard therapy. NPUS/NUU, UNC, and the successful interventional procedures did not differ significantly in terms of long-term results., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The incidence of surgical complications after kidney transplantation has been reported to range from 1% to 33%. The aim of this work was to report surgical urological complications among our cohort of 134 pediatric kidney transplantations. Epidemiological and clinical data of all patients younger than 18 years transplanted between January 1984 and May 2012 were collected from our prospective database. Urologic complications and management are reported herein. One hundred twenty-four patients, including 44% females underwent 134 renal transplants. Median age at the time of the surgery was 13 years. Mean time of end-stage renal disease was 25 months. We identified 10 subjects (7.5%) with urological complications: 5 ureterovesical stenoses, 2 lymphoceles, and 3 lower ureteral fistulas. All of the renal allografts were obtained from cadaveric donors. Mean age of these patients at the time of transplantation was 13 years. Mean cold ischemia time was 1613 minutes. All the patients required surgical management. All patients with ureterovesical stenoses underwent ureteral reimplantation using a Boari flap; those with lymphoceles underwent open marsupialization; 2 with ureteral fistulas underwent reimplantation of the ureter, and the other patient's case required placement of a nephrostomy tube and an antegrade ureteral catheter. All patients were treated successfully. Mean follow-up time of cases with urological complications was 9.5 years. Currently, 60% has nonfunctioning allografts; the mean current glomerular filtration rate of the functioning renal allografts is 55 mL/min. Despite requiring surgical management, all patients were treated successfully. Prompt identification and treatment of any complication are critical for graft and patient survival., (Copyright © 2013 Elsevier Inc. All rights reserved.)

VACTERL association is a nonrandom association of birth defects in vertebral, anal, cardiac, tracheoesophageal, renal, and limb structures. Renal anomalies are observed in ∼60%-90% of VACTERL patients. We present 3 cases to demonstrate the clinical and surgical challenges that these patients present for renal transplantation. One pediatric and 2 adult patients with the VACTERL association were transplanted at a single center; their follow-up times were 6 years, 4 years, and 3 months. Only 1 of them had a suitable native bladder to receive the kidney graft; the other 2 required bladder augmentation, 1 of which was performed after the loss of the first graft. None of these patients had an uneventful posttransplantation course. Two patients had acute rejection episodes, and 2 had reoperations for urologic complications. One patient needed a surgical intervention owing to a sigmoid prolapse. All 3 grafts worked at last examination. The 2 patients with bladder reconstructions and longer follow-ups suffered recurrent pulmonary and urinary infections and had been hospitalized several times during each posttransplantation year. In conclusion, multiorgan involvement in VACTERL patients greatly complicates medical care after transplantation; urinary tract reconstruction seems to be essential before transplantation., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Introduction: Urologic complications are an important cause of morbidity in kidney transplantation. To prevent this occurrence, several studies have reported the benefit of stenting. The aim of this study was to compare the efficacy of two different types of stents to protect the urinary anastomosis in kidney transplantation., Methods: We performed a retrospective analysis of 139 kidney transplant recipients who underwent ureteralneocystostomy by the Lich-Gregoire technique between January 1995 and July 2010. On the basis of the type of stent we divided transplant patients into two groups: group A (n=90), the internal-external Bracci catheter and group B (n=49), the double-J stent. The urologic complications evaluated in both groups were: urinary tract leakage, obstruction, and infections. We also recorded the duration of the postoperative hospitalization., Results: The incidences of urinary fistulae and ureteral strictures between the two groups were similar (around 3%). A higher incidence of urinary infections, however, was registered among group A compared with group B (46% vs 10%; P<.05). The postoperative hospitalization period was consequently longer in group A then group B (35 ± 3 vs 24 ± 2 days; P<.05)., Conclusion: In our series of kidney transplantations, the occurrence of urinary fistulae and ureteral strictures was not influenced by the type of stent. The use of a double-J stent, however, appeared to be associated with a significantly decreased incidence of urinary tract infections leading to shorter postoperative hospitalizations., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: Ureteral stents are used to reduce urologic complications after renal transplantation. However, they predispose to infection. The optimal time to keep them in the urinary tract has not yet been defined. The aim of this study was to evaluate the effect of early removal at the end of 2 weeks on urinary tract infections and early urologic complications (within 3 months), such as ureteroneocyctostomy leakage as well as ureteral anastomosis stricture or obstruction., Methods: We retrospectively analyzed the medical records of 48 patients who underwent renal transplantation using a ureteral stent. The patients were divided into two groups according to the time of stent removal: at the end of 2 weeks (group A; n = 10) versus at a later time (group B; n = 38)., Results: The urologic complication rate was 0% in group A and the urinary tract infection rate, 2%. The urologic complication rate was 0% in group B and the urinary tract infection rate, 35%., Conclusion: Early removal of the stent at the end of 2 weeks after renal transplantation is decreased the rate of urinary tract infections., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Urologic complications in renal transplantation are an important cause of morbidity and hospitalization. This retrospective study of 343 transplants, performed between 1999 and 2009, analyzed the incidence of urinary fistula (4.4%) and ureteral stenosis (3.5%), based upon the type of extravesical anastomosis-Woodruff (W) versus Taguchi (T)-and with versus without the use of a double-J stent. The frequencies of ureteral stenosis with a W anastomosis (without a double J), W+double J, or T+double J were 3.7%, 1.5%, and 9%, respectively (P=.031). There were differences between W+double J versus T+double J (P=.015), with a hazard ratio (HR)=6.3. In relation to a double-J stent, the incidences of fistulae among patients with a double-J stent were: W (12%) versus W+double J (0.8%) versus T+double J (0%; P<.0001; HR=15.8) versus patients without a double-J stent. Logistic regression showed the predictors of ureteral stenosis to be a urologic anastomosis (odds ratio 0.06, 95% confidence interval [CI]: 0.01-0.49) and delayed renal function (odds ratio 10.1, 95% CI: 1.4-72.4). Concerning fistulae, the best covariates were double-J stent (odds ratio 0.027, 95% CI: 0.003-0.227) and donor age (odds ratio 1.052, 95% CI: 1.01-1.096). A double-J stent protected against the development of a urologic fistula. Donor age was a risk factor. The W suture with a double-J stent was the best way to prevent ureteral stenosis, with delayed graft function being an important risk factor., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Despite a variety of urinary tract reconstructive techniques, urinary complications are the most frequent technical adverse event following renal transplantation. These complications can be associated with substantial morbidity and generate excess cost. In this review we comprehensively discuss 4 techniques of ureteroneocystostomy, compare complications, and evaluate the strengths and weaknesses of each technique focusing on 4 specific urologic complications: urine leak, ureteric obstruction, hematuria, and symptomatic vesicoureteral reflux.

Background: Living donor kidney transplants with multiple arteries are presumed to be associated with an increased risk of complications., Objectives: The aim of the study was to compare the outcomes in living donor transplantation with the specific intention of comparing long-term outcomes in which the donor kidney had 1 or more renal arteries. The study was undertaken in 2 large transplant centers., Methods: A retrospective analysis of 201 living donor kidney transplants with multiple arteries that were performed between January 1985 and December 2004 was undertaken. We recorded patient and graft survivals, urological and vascular complications. Kaplan-Meier survival estimates were calculated, and 2-tailed Student t-test was used to compare outcomes. P < .05 was considered statistically significant., Results: Graft and patient survival at 1 year were 93% and 97% and at 5 years were 87% and 92%. The most common complications were vascular (8.9%), followed by urological (6%), acute tubular necrosis (5.5%), and posttransplant hypertension (4.0%). There was significantly higher incidence of acute tubular necrosis (ATN) in multiple-artery transplants., Conclusion: In this large cohort of patients studied, apart from a higher incidence of ATN and vascular complications, it appears that the number of renal arteries did not have any adverse impact on the outcomes. The findings from this study suggest that live donor kidneys with multiple renal arteries can be safely utilized for renal transplantation.

Objectives: We sought to explore the incidence, risk factors, clinical presentation, management options, and outcomes of post renal transplant urologic complications., Patients and Methods: Between November 1993 and December 2005, we performed 646 renal transplantation procedures in 373 males and 273 females, of whom 81 were children. Kidney grafts were obtained from 461 living and 185 cadaveric donors. The medical records were retrospectively reviewed for urologic complications. Affected patients presented clinically with impaired kidney function: the diagnosis was confirmed by ultrasound scanning, isotope renal scanning, magnetic resonance urography, and/or antegrade urography. Ureteric stricture was managed by percutaneous antegrade ureteric dilatation and stenting, or by surgical reconstruction. Urine leak was treated by prolonged bladder drainage or surgical reconstruction. Renal stones were treated with extracorporeal shockwave lithotripsy., Results: Urologic complications were detected in 31 recipients (4.8%), including 21 males and 10 females, among whom 4 were children. They had received kidney grafts from 19 living and 12 cadaveric donors. Urologic complications were ureteric strictures in 15 (2.58%), urine leaks in 15 (2.58%), and ureteric stone in 1 (0.17%) recipients. There was no graft loss to urologic complications., Conclusions: The incidence of post-kidney transplant urologic complications was 4.8%. They were more common among male recipients and after cadaveric kidney transplantation. Although ureteric stricture presented late posttransplantation and was more common among children (4.23%), urine leak presented early and was more common in the elderly (4.69%). All urologic complications were successfully managed, with no graft loss.

Introduction: Renal transplantation in patients with lower urinary tract dysfunction (LUTD) of various origins is a challenging issue in the field of pediatric transplantation. We report our single-center experience to evaluate patient and graft survivals as well as the risks of the surgery and immunosuppressive therapy., Patients and Methods: Among 70 pediatric transplant patients, 11 displayed severe LUTD. Videourodynamic tests were performed on all patients preoperatively as well as postoperatively if required. The cause of urologic disorders were neurogenic bladder (n = 5) and urethral valves (n = 6). Clean intermittent catheterization (CIC) was needed in six patients to empty the bladder. To achieve a low-pressure reservoir with adequate capacity pretransplantation augmentation ileocystoplasty was created in four patients and gastrocystoplasty in one patient. Three of the patients received kidneys from cadaveric and eight from living donors. All patients were treated with calcineurin-based immunosuppressive therapy., Results: The mean age at transplantation was 15 +/- 4.7 years. The median follow-up after transplantation was 36 months (6 to 62 months). At their last visit the median creatinine level was 0.95 mg/dL (0.8 to 2.4 mg/dL). Three patients had recurrent symptomatic urinary tract infections who had augmented bladder on CIC. One patient with ileocystoplasty who developed urinary leak and ureteral stricture in the early postoperative period was treated by an antegrade J stent., Conclusion: Severe LUTD carried high risks for the grafted kidney. However, our data suggested that renal transplantation is a safe and effective treatment modality, if the underlying urologic diseases properly managed during the transplantation course. Since surgery and follow-up is more complicated, patient compliance and experience of transplantation team have significant impacts on outcomes.

Aim: The incidence of urologic complications after renal transplantation has been reported to be between 2.5% and 27%. The aim of this study was to evaluate urologic complications of and their surgical treatment in our series of renal transplantations., Materials and Methods: We retrospectively evaluated urologic complications among 395 renal transplant recipients in our institute., Results: The urologic complications were ureteral leakage (n = 8), stricture of ureteral anastomosis (n = 3), hydronephrosis secondary to stone (n = 2) and bladder outlet obstruction (n = 2), recurrent urinary infection because of vesicoureteral reflux to native kidney (n = 2), renal tumor in native kidney (n = 1), hydroceles (n = 3), technical complications (n = 2), and clot retention (n = 1)., Conclusion: Major urologic complications following renal transplantation are ureteral leakage and stricture resulting from disrupture of the distal ureteral blood supply during the donor operation. Extravesical ureteroneocystostomy over a JJ stent seems feasible to minimize urologic complication. Early diagnosis and endourologic techniques are the mainstays of treatment.

Urologic complications, observed since the beginning of renal transplantation, cause significant morbidity and mortality. In the first few years the procedure was performed, incidence of urologic complications was reported to be 10% to 25%. Recently, the incidence of urologic complications after renal transplantation has decreased to 2.5% to 12.5%; unfortunately, a higher incidence exists in pediatric recipients, reaching approximately 20% with an associated 58% and 74% graft survival rates for cadaveric and living-related transplantation, respectively. We retrospectively analyzed the postoperative urologic complications reported in the medical charts of 1523 consecutive kidney transplantations (1130 men, 74.2%; 393 women, 25.8%; mean age, 31.9 +/- 10.9 years; range, 7 to 64 years; 354 cadaveric, 23.2%; 1169 living, 76.8%) performed by our team since 1975. The first 321 procedures took place at Hacettepe University Hospital in Ankara, Turkey, and the remaining 1202 were performed at Baskent University Hospital in Ankara. Urologic complications occurred in 46 (3%) recipients. Twenty-three (1.5%) of these patients had urine leakage, 15 (1%) had urinary obstruction due to ureteral stricture, 6 (0.4%) had distal ureter necrosis, and 2 (0.1%) developed renal calculi in the late postoperative period. Twenty-four out of 46 required reoperation for urologic complications. The remaining 22 patients were treated conservatively in our interventional radiology department with excellent results. In conclusion, urologic complications will always occur in the posttransplant period. Early diagnosis by experienced personnel and use of interventional radiology can greatly reduce the need for surgical treatment.

Urological complications after kidney transplantation develop in 2.5% to 14.1% of recipients. The aim of the study was to analyze postoperative urological complications that required surgical treatment. Thirty-three urological complications developed in 30 among 321 patients (9.3%). Complications were divided into two groups: I, related to urine retention (60.6%); and II, related to urine leakage (39.4%). For 70% of group I, in patients a double pigtail ureteral stent was inserted; for 53.8% of group II, a vesicoureteric reanastomosis was performed. Good urine outflow was achieved in 90.0% of patients. Total early graft loss was 20% of patients. Urological complications related to stenosis or leakage can be treated with ureteral stent insertion or vesicoureteral reanastomosis. Hemorrhage or infection coexisting with a urological complication increased the risk of early graft loss. Long-term graft survival among patients after successful treatment of urological complications was similar to that of patients without them.

Background: Renal transplantation is associated with several nonimmunological problems. Although urologic complications may be serious and carry a high risk of graft loss, they are amenable to successful treatment if diagnosed early and treated properly. Their incidence in the literature varies from 2.5% to 15%., Objective: We sought to assess the incidence, pattern, management options, and outcomes of urologic complications in 560 consecutive renal transplantations performed at a single center between November 1993 and October 2004., Patients and Methods: Twenty-one (16 male and 5 female) recipients developed posttransplantation urinary complications at 2 days to 76 months after renal transplantation. Their kidney grafts were obtained from 13 living and eight deceased donors. Complications included ureteric stricture in 11 and urine leak in 10 recipients. Ultrasonography and isotope renal scanning were the main diagnostic tools. Complications were treated either conservatively, by percutaneous dilatation and stenting, or by surgical reconstruction., Results: The incidence of urologic complications following renal transplantation in the present series was 3.7%. All cases were successfully treated with no graft loss secondary to these complications., Conclusions: Posttransplantation urologic complications are associated with a good prognosis if diagnosed early and properly treated. Percutaneous transluminal dilatation of ureteric stenosis in renal transplant patients has good initial success, low morbidity, few recurrences, and long-term effectiveness.

Urologic complications in kidney transplantation have an incidence ranging from 3% to 20%, representing an important cause of organ loss. From January 2001 to September 2004, 123 renal transplantations were performed using an immunosuppressive protocol including basiliximab, mycophenolate mofetil, calcineurin inhibitors, and steroids. The surgical technique was vascular anastomoses to external iliac vessels, and ureteral anastomosis according to Lich Gregoire technique using a JJ ureteral stent. We report 5 renal complications (4.2%) and 4 extrarenal complications (3.5%), the majority of which required corrective surgery. The surgical strategy uses the clinical condition of the donor and the recipient; the anatomic anomalies of the graft, and a reduced cold ischemia time. Moreover, a reduction in acute rejection episodes and immediate renal function has been fundamental to reduce urologic complications. In fact, the main cause of urologic complications is ureteral ischemia, linked both to backtable surgery and to rejection episodes. Another important factor in the reduction of early urologic complications has been the routine use of a JJ stent, which allowed us a conservative approach in this setting.

In our initial experience of kidney transplantation, we performed an extravesical uretero-cystostomy (U-C), but in 1997 we shifted to a uretero-ureterostomy (U-U) with the aim of reducing early and late urological complications. A data base was constructed to compare the incidence, donor and recipient risk factors, treatments, and outcomes of urological complications with the two techniques. From 1990 to the end of July 2004, 894 kidney transplants included 43 from living donors and 851 from cadaveric donors with 804 first and 47 second transplants. We observed 48 urinary fistulas (5.4%): 45 were successfully repaired and three were treated with a ureteral stent with two good results; and one failed at a late operation. We had 26 early stenoses (2.9%), all of which were successfully treated: 16 with surgery and 10 with a stent. Donor and recipient risk factors for fistula and early stenosis did not reach statistical significance, confirming the technical etiology of these complications. There were only six cases of late ureteral stenosis in patients operated after 1990, and in eight cases of U-C we observed vesico ureteral reflux. There were 88 urological complications, with only one kidney lost. The shift from U-C to U-U did not change the incidence of urological complications, but with U-U we observed a significant decrease in the number of postoperative urinary infections, an easier possibility to resolve ureteral stenosis with endourology and no reflux. It is now our first choice with a normal ureter.

Kidney transplantation in rats is a useful model for microsurgery, transplantation, and immunology studies. Our aim was to analyze various techniques of kidney transplantation in rats with emphasis on guidelines for the prevention and management of complications. Complications were categorized into general, vascular, and urological types and respectively attributed to long transplantation time, core body temperature drop, nonreplaced intraoperative blood loss, anastomosis failure, and ureteral anastomoses with stents or cannulas, which increase the risk of calculus formation. In conclusion, to decrease the complication rates the animal should be placed on a heating pad. For hemodynamic stability NaCl should be administered subcutaneously. To reduce the risk of thrombosis, ice-cold saline containing heparin should be administered. Vascular complications, which mainly depend on the microsurgeon's expertise, can be prevented by meticulous surgical technique (preferably an end-in-end anastomosis). The main urinary complications can be minimized by avoiding stents and cannulas and focusing on using techniques like the bladder-patch technique.

Background: Renal transplantation is an effective treatment for end-stage renal disease. Ureteral stenosis is the most frequent urologic complication. We report our long-term follow-up results concerning endourologic treatment of ureteral obstruction after renal transplantation., Methods: Between May 1997 and September 2000, 15 patients with renal transplant obstructive uropathy were managed with percutaneous nephrostomy and prolonged ureteral stenting., Results: Percutaneous nephrostomies were performed successfully in all 15 kidneys. In 13 patients, antegrade ureteral stenting was attempted, which was successful in 11 patients (85%). After prolonged ureteral stenting (mean duration 15 months), the stent was removed in all patients, 90% of whom had no recurrence. During follow-up (36 to 71 months; mean 51), urea, creatinine, sodium, and potassium determinations and ultrasound scans were performed. Success was defined as a reduction in hydronephrosis. No major complications were observed., Conclusions: Modern endourologic procedures have replaced open reconstructive surgery in most patients with ureteral obstruction after renal transplantation, because they may offer a definitive treatment with low morbidity., (Copyright 2004 Elsevier Inc.)

Aim: To assess the incidence of urological complications and hematuria after adult kidney transplantation using the Lich-Gregoire (LG) versus the Taguchi (T) ureteral implantation technique., Methods: We performed a retrospective analysis of 212 consecutive kidney transplants from our institution using an access database., Results: Sixty four patients underwent ureteral implantation using the T technique, and the other 148, the LG implantation. Both groups were matched for donor/recipient characteristics and for cold/warm ischemia times. There were 23 urological complications in 17 patients. Twenty-seven patients developed complicated hematuria. The rates of urinary leak and ureteral stones were not different. There was a higher incidence of permanent ureteral strictures using the LG technique (P =.05). T technique was associated more frequently with hematuria, but there was no difference in the length of stay., Conclusions: We identified an increased incidence of permanent strictures with the LG technique. The rate of hematuria was higher in the T group. Both techniques can be used interchangeably with acceptable rates of urological complications. The simplicity of the T technique has made it the technique of choice in our institution.

In summary, we feel that excellent 5-year patient and graft survival results can be obtained using SPK transplantation with bladder drainage technique. Despite the good results, a significant morbidity with prolonged hospitalization is seen after pancreas transplantation. This increased morbidity is due to infectious complications, rejection and urological complications. As a result of the popularity of bladder drainage, the complications after pancreas transplantation have shifted from intraabdominal to urological. Enteric conversion after SPK transplantation is the treatment of choice for chronic hematuria and a duodenal segment leak. In our hands this method appeared to be a safe and reliable procedure with a low complication rate. Enteric conversion should be considered in early leaks after failure of one attempt to suture repair the anastomotic site. In larger leaks or late leaks, it is advisable to perform an immediate enteric conversion. With the considerations above one might ask why enteric conversion is not our current primary choice for the initial transplant procedure. We have, however, noted a higher incidence of postoperative intraabdominal septic complications as well as mycotic aneurysms at the arterial suture line in a small series of 16 primarily enterically drained pancreas transplants. We also fear that the leakage rate after primary duodenoenteric drainage could be higher because of significant edema after transplantation in the preserved duodenal segment. We doubt, therefore, that the primary anastomosis with the bowel is as safe as one performed during enteric conversion when preservation injury has been resolved. At that point the patient is in stable condition and on significantly lower doses of immunosuppression than at the time of transplantation. This study demonstrates that urological complications constitute a major part of the morbidity after SPK transplantation. Despite this fact, appropriate treatment including enteric conversion can resolve most of the complications and prevent long-term morbidity or even graft loss.

This report describes the successful treatment in a transplant recipient of a case of MK originating from the native urinary tract. As demonstrated, MK may pursue unexpected patterns to which conventional therapeutic guidelines may not be applicable. The type of surgical intervention used must be dictated by the extent and location of the disease and its complications. Withdrawal of immunosuppressive medication was useful in improving the patient's prognosis.