Ureteropyelostomy with the recipient's native ureter: A safe and efficacious alternative in managing urological complications of renal transplantation

Objective: The most common urological complications after renal transplanta tion are ureteral obstruction and leakage of the ureteroneocystostomy. The aim of this study is to present our experience in managing these complicati ons through the performance of ureteropyelostomy using the recipient's nati ve ureter in those cases in which reimplantation of the transplant ureter t o the bladder, as well as percutaneous procedures, were impossible or have failed. Patients and Methods: Between March 1983 and December 1998, 749 renal trans plantations were performed in our unit. A total of 42 cases (5.6%) with a u rological complication were recorded, from which 23 and 11 patients present ed ureteral obstruction and leakage of the ureteroneocystostomy, respective ly, while the remaining 8 patients presented less common complications. In 13 of the 23 patients with obstruction, as well as in 2 of the 11 patients with leakage, ureteropyelostomy was performed. Of the 19 remaining patients , 14 underwent reimplantation of the transplant ureter, while 5 were treate d more conservatively. Results: All 15 patients tolerated ureteropyelostomy uneventfully, and no d eaths related to the operation occurred. The cause of ureteral obstruction among patients who underwent ureteropyelostomy was fibrosis in 9 patients ( 69.2%), kinking of the ureter in 2 patients (15.4%), presence of blood clot s in the pelvis and ureter of the transplant in 1 patient (7.7%), and compr ession by a germ cell carcinoma in 1 patient (7.7%). Renal function returne d to normal postoperatively in the 2 patients suffering from leakage as wel l as in 10 patients with ureteral obstruction, while the remaining 3 obstru cted patients developed chronic renal failure despite the successful urinar y tract restoration. Conclusion: Use of the recipient's native ureter, when in good condition, i s a valuable means for management of the most common urological complicatio ns after renal transplantation-namely, ureteral obstruction and leakage of the ureteroneocystostomy.