Diagnosis and management of ureteral complications following renal transplantation

Abstract

When compared with maintenance dialysis, renal transplantation affords patients\rwith end-stage renal disease better long-term survival and a better quality of life. Approximately\r9% of patients will develop a major urologic complication following kidney transplantation.\rUreteral complications are most common and include obstruction (intrinsic and\rextrinsic), urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result\rfrom technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered\rfor short, low-grade strictures, but open reconstruction is associated with higher success\rrates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be\rsuccessfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral\rstent, and indwelling bladder catheter). Proximal, large-volume, or leaks that persist\rdespite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation.\rPatients with recurrent pyelonephritis despite antimicrobial prophylaxis require\rsurgical treatment. Deflux injection may be considered in recipients with low-grade disease.\rGrade IV and V reflux are best managed with open reconstruction