The Development and Current Status of Minimally Invasive Surgery to Manage Urological Complications After Renal Transplantation

Overview

Journal Indian J Urol

Specialty Urology

Date 2016 Aug 25

PMID 27555675

Citations 4

Authors

Ravindra B Sabnis

Abhishek G Singh

Arvind P Ganpule

Jaspreet S Chhabra

Gopal R Tak

Jaimin H Shah

Affiliations

Soon will be listed here.

Abstract

Introduction: In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques.

Materials And Methods: A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed.

Results: The incidence of urological complications postrenal transplantation was reported to be 2-13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50-70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients.

Conclusion: Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy.

Citing Articles

Impact of early surgical complications on kidney transplant outcomes.

Minkovich M, Gupta N, Liu M, Famure O, Li Y, Selzner M BMC Surg. 2024; 24(1):165.

PMID: 38802757 PMC: 11129490. DOI: 10.1186/s12893-024-02463-7.

Ureteral strictures post-kidney transplantation: Trends, impact on patient outcomes, and clinical management.

Minkovich M, Famure O, Li Y, Ghanekar A, Selzner M, Kim S Can Urol Assoc J. 2021; 15(10):E524-E530.

PMID: 33750520 PMC: 8525535. DOI: 10.5489/cuaj.7003.

Early urological complications after kidney transplantation: An overview.

Buttigieg J, Agius-Anastasi A, Sharma A, Halawa A World J Transplant. 2018; 8(5):142-149.

PMID: 30211022 PMC: 6134271. DOI: 10.5500/wjt.v8.i5.142.

Critical appraisal of consecutive 36 cases of post renal transplant lymphocele: a proposed algorithm.

Singh A, Jai S, Ganpule A, Vijaykumar M, Sabnis R, Desai M World J Urol. 2017; 35(9):1443-1450.

PMID: 28138768 DOI: 10.1007/s00345-016-1997-x.

References

He B, Bremner A, Han Y . Classification of ureteral stenosis and associated strategy for treatment after kidney transplant. Exp Clin Transplant. 2013; 11(2):122-7. DOI: 10.6002/ect.2012.0179. View

Thomalla J, Lingeman J, Leapman S, Filo R . The manifestation and management of late urological complications in renal transplant recipients: use of the urological armamentarium. J Urol. 1985; 134(5):944-8. DOI: 10.1016/s0022-5347(17)47540-9. View

Duty B, Conlin M, Fuchs E, Barry J . The current role of endourologic management of renal transplantation complications. Adv Urol. 2013; 2013:246520. PMC: 3760203. DOI: 10.1155/2013/246520. View

Stravodimos K, Adamis S, Tyritzis S, Georgios Z, Constantinides C . Renal transplant lithiasis: analysis of our series and review of the literature. J Endourol. 2011; 26(1):38-44. DOI: 10.1089/end.2011.0049. View

Cimic J, Meuleman E, Oosterhof G, Hoitsma A . Urological complications in renal transplantation. A comparison between living-related and cadaveric grafts. Eur Urol. 1997; 31(4):433-5. DOI: 10.1159/000474502. View

Duepree H, Fornara P, Lewejohann J, Hoyer J, Bruch H, Schiedeck T . Laparoscopic treatment of lymphoceles in patients after renal transplantation. Clin Transplant. 2001; 15(6):375-9. DOI: 10.1034/j.1399-0012.2001.150602.x. View

He Z, Li X, Chen L, Zeng G, Yuan J, Chen W . Endoscopic incision for obstruction of vesico-ureteric anastomosis in transplanted kidneys. BJU Int. 2008; 102(1):102-6. DOI: 10.1111/j.1464-410X.2008.07604.x. View

Reinberg Y, Manivel J, Sidi A, Ercole C . Transurethral resection of prostate immediately after renal transplantation. Urology. 1992; 39(4):319-21. DOI: 10.1016/0090-4295(92)90205-b. View

Gdor Y, Gabr A, Faerber G, Wolf Jr J . Holmium:yttrium-aluminum-garnet laser endoureterotomy for the treatment of transplant kidney ureteral strictures. Transplantation. 2008; 85(9):1318-21. DOI: 10.1097/TP.0b013e31816c7f19. View

10.

Habbig S, Beck B, Feldkotter M, Korber F, Laffeber C, Verkoelen C . Renal allograft calcification -- prevalence and etiology in pediatric patients. Am J Nephrol. 2009; 30(3):194-200. DOI: 10.1159/000217585. View

11.

Bhayani S, Landman J, Slotoroff C, Figenshau R . Transplant ureter stricture: Acucise endoureterotomy and balloon dilation are effective. J Endourol. 2003; 17(1):19-22. DOI: 10.1089/089277903321196733. View

12.

Dominguez J, Clase C, Mahalati K, MacDonald A, McAlister V, Belitsky P . Is routine ureteric stenting needed in kidney transplantation? A randomized trial. Transplantation. 2000; 70(4):597-601. DOI: 10.1097/00007890-200008270-00011. View

13.

Fontaine A, Nijjar A, Rangaraj R . Update on the use of percutaneous nephrostomy/balloon dilation for the treatment of renal transplant leak/obstruction. J Vasc Interv Radiol. 1997; 8(4):649-53. DOI: 10.1016/s1051-0443(97)70625-0. View

14.

Katz R, Pode D, Gofrit O, Shenfeld O, Landau E, Golijanin D . Transurethral incision of ureteroneocystostomy strictures in kidney transplant recipients. BJU Int. 2003; 92(7):769-71. DOI: 10.1046/j.1464-410x.2003.04455.x. View

15.

Nohara T, Matsuyama S, Shima T, Kawaguchi S, Seto C . Holmium Laser Enucleation of the Prostate With Percutaneous Nephrostomy Into the Transplanted Kidney in Patient With Severe Benign Prostatic Hyperplasia With Vesicoureteral Reflux - A Case Report. Urol Case Rep. 2016; 4:33-5. PMC: 4719790. DOI: 10.1016/j.eucr.2015.11.003. View

16.

Smith R, Ehrlich R . The surgical complications of renal transplantation. Urol Clin North Am. 1976; 3(3):621-46. View

17.

Klingler H, Kramer G, Lodde M, Marberger M . Urolithiasis in allograft kidneys. Urology. 2002; 59(3):344-8. DOI: 10.1016/s0090-4295(01)01575-8. View

18.

Zietek Z, Sulikowski T, Tejchman K, Sienko J, Janeczek M, Iwan-Zietek I . Lymphocele after kidney transplantation. Transplant Proc. 2007; 39(9):2744-7. DOI: 10.1016/j.transproceed.2007.08.041. View

19.

Bach C, Kabir M, Zaman F, Kachrilas S, Masood J, Junaid I . Endourological management of ureteric strictures after kidney transplantation: Stenting the stent. Arab J Urol. 2015; 9(3):165-9. PMC: 4150573. DOI: 10.1016/j.aju.2011.08.001. View

20.

Rao P, Merion R, Ashby V, Port F, Wolfe R, Kayler L . Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation. 2007; 83(8):1069-74. DOI: 10.1097/01.tp.0000259621.56861.31. View