Diagnosis and management of ureteral complications following renal transplantation

doi:10.1016/j.ajur.2015.08.002

Asian Journal of Urology, 2015, 2 (4): 202-207 doi: 10.1016/j.ajur.2015.08.002

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Diagnosis and management of ureteral complications following renal transplantation

Brian D. Duty^a, John M. Barry^a,b

a Department of Urology, Oregon Health & Science University, Portland, OR, USA;
b Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, OR, USA

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Abstract When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic), urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter). Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.

Key words： Renal transplantation Ureteral stricture Ureteral obstruction Urine leak Vesicoureteral reflux

Received: 14 March 2015 Published: 29 October 2015

Corresponding Authors: Brian D. Duty E-mail: dutyb@ohsu.edu

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Brian D. Duty,John M. Barry. Diagnosis and management of ureteral complications following renal transplantation[J]. Asian Journal of Urology, 2015, 2(4): 202-207.

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http://www.ajurology.com/EN/10.1016/j.ajur.2015.08.002 OR http://www.ajurology.com/EN/Y2015/V2/I4/202

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