G. Zavos et al., Ureteropyelostomy with the recipient's native ureter: A safe and efficacious alternative in managing urological complications of renal transplantation, DIALYSIS T, 29(12), 2000, pp. 783
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.