Operative technique and urological complications in kidney transplantation
Abstract
Between January 30, 1971 and January 30, 2004, 767 kidney transplants were performed at our center, 348 (45.37%) from living related donor and 419 (54.63%) from cadaver. During first eight years an ureteroureterostomy was routinely used. The notable incidence of urological complications (fistula 12%, complications of stenting 10.7%, stenosis and lithiasis 4%) was observed after 140 transplants. Majority of these complications (60%) were treated conservatively. A significant reduction in this incidence (P<0.001) was achieved (fistula 1.12%, complications of stenting 0.32%, lithiasis 0.16%) by introducing an extravesical ureteroneo-cystostomy by Lich-Gregoire. Stenosis had the highest incidence (3.67%). Unfortunately two patients with urinary fistula died in the early phase of its application, before the routine use of ultrasound. Majority of complications (82%) were treated surgically. A native ureter was commonly used in replacing the transplant ureter. In majority of patients an end-to-end pyelo(uretero)stomy was performed. Two patients were reoperated because of fistula, and the third had a prolonged healing. In last five patients with urological complicatons an end-to-side pyelo(uretero)stomy was done. There was no urinary leakage. The safety of method results probably from an intact native ureter which has normal blood irrigation. > <0.001) was achieved (fistula 1.12%, complications of stenting 0.32%, lithiasis 0.16%) by introducing an extravesical ureteroneo-cystostomy by Lich-Gregoire. Stenosis had the highest incidence (3.67%). Unfortunately two patients with urinary fistula died in the early phase of its application, before the routine use of ultrasound. Majority of complications (82%) were treated surgically. A native ureter was commonly used in replacing the transplant ureter. In majority of patients an end-to-end pyelo(uretero)stomy was performed. Two patients were reoperated because of fistula, and the third had a prolonged healing. In last five patients with urological complicatons an end-to-side pyelo(uretero)stomy was done. There was no urinary leakage. The safety of method results probably from an intact native ureter which has normal blood irrigation.
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References
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