Surgical Treatment for Ureteral Complications Following Renal Transplantations

Abstract

Objective Ureteral stenosis and necrosis are the most common urological complications after a renal transplantation. Surgery is the treatment of choice in ureteral necrosis, whereas surgery, percutaneous approaches and laser endoureteromy may be applied in ureteral stenosis. The aim of this study was to review the causes of and surgical treatment methods for ureteral complications following renal transplantations. Materials and Methods One hundred sixty renal transplantations were performed from both cadaveric and live donors at our transplantation center between 2011 and 2014. Demographic features, complication types, surgical methods and the treatment results in 10 patients, who required surgical intervention due to ureteral complications, were recorded. Data was collected retrospectively through patient charts. Results Patients who were operated on because of ureteral complications were enrolled in the study. Six patients (3.75%) had ureteral stenosis, and 4 patients (2.5%) had ureteral necrosis. Three of these transplantations were made from living donors (2 female and 1 male) and 7 were from cadavers (1 female and 6 male). Extravasation was found in 4 patients due to necrosis, all encountered in the second week of operation. Two patients underwent native ureteropyelostomy and two underwent ureteroneocystostomy for ureteral necrosis. One patient underwent ureteroureterostomy, four had ureteroneocystostomy, and one had native ureteropyelostomy for stenosis. One patient experienced postoperative urine leakage and underwent native ureteropelvic anastomosis. Conclusion In our study, urological complications following renal transplantation were mostly seen after cadaveric renal transplantations. Ureteral stenosis was the most commonly encountered complication. Urinary tract infection levels were statistically high in patients with ureteral complications. Successful outcomes were achieved in all surgical methods. Ureteroneocystostomy and native ureteropyelostomy may be preferred for treating ureteral complications in suitable patients. Choice of treatment should be determined according to the patient and cause. Large scale studies are required in order to identify which treatment is more favorable.

Keywords

• Ureteral complications
• renal transplantations
• surgical treatment