1
|
Astolfi RH, Aguiar WF, Viana L, Cristelli M, Junior HTS, Pestana JM. A STENTLESS MODIFIED LICH-GREGOIR TECHNIQUE FOR SAFE EARLY BLADDER CATHETER REMOVAL IN LIVING AND DECEASED KIDNEY TRANSPLANTS. Urology 2022; 165:336-342. [PMID: 35065141 DOI: 10.1016/j.urology.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe a stentless modified Lich-Gregoir technique (mLG) for ureteroneocystostomy in renal transplantation (RT), with early bladder catheter (BC) removal (under 48 hours), and compare the postoperative results with those of the traditional technique (LG) with routine bladder catheter removal (4 to 5 days). The modification consists of maintaining a thin layer of detrusor fibers covering the bladder mucosa during dissection, which is incorporated into the anastomosis to reinforce the ureteroneocystostomy. MATERIALS AND METHODS This retrospective cohort study compared the postoperative outcomes of 100 consecutive patients who underwent mLG with early removal of BC between October 2018 to November 2019 with those of a historical cohort of 165 consecutive patients transplanted using stentless LG and routine removal of BC, who underwent surgery between July 2017 and September 2018. All transplants were performed by the same surgeon. Follow-up was 6 months. RESULTS Demographic characteristics were comparable, although patients in the mLG group had a higher mean preoperative urine volume (911±753.8mL vs. 629±638.6mL, p=0.016). Patients in the mLG group successfully underwent early BC removal (2.2±0.9 vs. 4.8±4.8 days, p<0.001), with no differences in the incidence of surgical or clinical complications, including urine leaks (1 vs. 3%, p=0.284). In addition, mLG patients presented a shorter mean length of hospital stay (6.5±5.0 vs. 7.1±6.2 days, p=0.023). CONCLUSION This stentless modified Lich-Gregoir technique enables safe early bladder catheter removal and is associated with reduced hospital length of stay.
Collapse
Affiliation(s)
- Rafael H Astolfi
- Department of Urology, Endourology Division, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil.
| | - Wilson F Aguiar
- Department of Urology, Endourology Division, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil; Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Laila Viana
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Marina Cristelli
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Helio T S Junior
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| | - Jose M Pestana
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, SP, Brazil
| |
Collapse
|
2
|
Sarier M, Yayar O, Yavuz A, Turgut H, Kukul E. Update on the Management of Urological Problems Following Kidney Transplantation. Urol Int 2021; 105:541-547. [PMID: 33508852 DOI: 10.1159/000512885] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
Urological problems in kidney transplant recipients are not limited only to posttransplantation urological complications. These problems are a cause of significant patient mortality and morbidity that have wide-ranging effects on graft survival throughout the entire life of the graft. Ultimately, the transplant comprises a major portion of the urinary system; therefore, the transplant team should be prepared for foreseeable and unforeseeable urological problems in the short and long terms. These mainly include postoperative urological complications (urine leakage, ureteral stenosis, and vesicoureteral reflux), bladder outlet obstruction, and graft urolithiasis. In recent years, significant advances have been made in the management of urological complications, especially due to advances in endourologic interventions. The aim of this review is to summarize the management of urological problems after kidney transplantation in the context of the current literature.
Collapse
Affiliation(s)
- Mehmet Sarier
- Department of Urology, Istinye University, Istanbul, Turkey,
| | - Ozlem Yayar
- Department of Nephrology, Medical Park Hospital, Antalya, Turkey
| | - Asuman Yavuz
- Department of Nephrology, Medical Park Hospital, Antalya, Turkey
| | - Hasan Turgut
- Faculty of Health Science, Avrasya University, Trabzon, Turkey
| | - Erdal Kukul
- Department of Urology, Medical Park Hospital, Antalya, Turkey
| |
Collapse
|
3
|
Churchill BM, Sharma A, Aziz D, Halawa A. Identifying Early Extraperitoneal High-Volume Urine Leak Post Kidney Transplantation. EMJ 2021. [DOI: 10.33590/emj/20-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Transplant clinicians need to be watchful of several potential surgical complications in the early post-transplant period, including haemorrhage, extraperitoneal urine leak, and lymphocele. While haemorrhage and extraperitoneal urine leak usually present in the early post kidney transplant period, lymphoceles usually present 2–6 weeks after transplantation. While the colour and volume of the drained fluid can give some indication of the problem, is not enough evidence for a confident urine leak diagnosis. Further investigations, such as serum biochemical parameter analysis of the drained fluid and ultrasonography, help to identify the true cause. This paper discusses how to identify high-volume extraperitoneal urine leaks in the early post kidney transplant period and considers the differential diagnoses. Different ureteroneocystostomy procedures, including the Lich–Grégoir, Politano–Leadbetter, and U-stitch techniques, are discussed and compared regarding complication rates (especially urine leak and haematuria). The authors also address the management of low- and high-volume extraperitoneal urine leak, the follow-up needed, and the impact of urine leak on graft and patient survival, length of hospital stay, and rate of hospital readmission.
Collapse
Affiliation(s)
| | - Ajay Sharma
- Postgraduate Education in Transplantation, University of Liverpool, Liverpool, UK; Department of Transplantation, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Davis Aziz
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Ahmed Halawa
- Postgraduate Education in Transplantation, University of Liverpool, Liverpool, UK; Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, UK
| |
Collapse
|
4
|
Jenjitranant P, Tansakul P, Sirisreetreerux P, Leenanupunth C, Jirasiritham S. Risk Factors for Anastomosis Leakage After Kidney Transplantation. Res Rep Urol 2020; 12:509-516. [PMID: 33150141 PMCID: PMC7604254 DOI: 10.2147/rru.s272899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Kidney transplantation is one of the best treatment options for end-stage renal disease with an incidence of urologic complications of 2.5 to 30%. One of the most serious and frequent urological complications is urinary leakage from ureteroneocystostomy anastomosis. The purpose of this study was to evaluate risk factors of urinary leakage from ureteroneocystostomy anastomosis after kidney transplantation. Patients and Methods A retrospective study was performed on patients who received kidney transplantation and were diagnosed with urinary leakage thereafter based on renal scan or drain creatinine per serum creatinine compared with patients in control group. Risk factor assessment was based on inpatient and outpatient information from hospital database. Results From 459 patients who received kidney transplantation in 2016-2018, there were 20 patients who were diagnosed with urinary leakage after they underwent ureteroneocystostomy anastomosis. The significant risk factors for anastomosis leakage were size of suture materials and duration of ureteral stent insertion. No statistically significant difference in other factors such as underlying disease, surgical technique or duration of urinary catheter was found. About overall urological complication, gender and body mass index significantly affected the outcome. Conclusion The rate of urinary leakage complications was found to be about 4.36%. The risk factors of overall complication comprised gender and body mass index. Although a lot of previous studies revealed many risk factors that could affect urinary leakage, size of suture materials and duration of ureteral stent insertion were the significant risk factors in our study. Proper consideration should be given to the size of suture materials and optimal duration of ureteral stent.
Collapse
Affiliation(s)
- Pocharapong Jenjitranant
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pasu Tansakul
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pokket Sirisreetreerux
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Charoen Leenanupunth
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sopon Jirasiritham
- Division of Vascular and Transplant Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
5
|
Abdo N, Murez T, Cabaniols L, Robert M, Marchal S, Amadane N, Thezenas S, Iborra F, Thuret R. [Results of surgical revisions for ureteral complications after renal transplantation]. Prog Urol 2019; 29:474-81. [PMID: 31400962 DOI: 10.1016/j.purol.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/25/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze the results of surgical revision for ureteral complication (ureteric stenosis or urinary leakage) after renal transplantation over a period of 10 years. MATERIALS AND METHODS We performed a retrospective study on 1313 consecutive kidney transplantations carried out in a University Hospital Center between 2005 and 2014. The data of the patients who developed a ureteral stenosis or a urinary leakage secondary to a renal transplantation were analyzed. Combined organ transplantations (kidney-liver and kidney-pancreas), as well as pediatric transplantations were excluded. RESULTS Seventy-six patients (5.8%) had ureteric stenosis or urinary leakage after renal transplantation. Forty-six patients (3.5%) underwent surgical revision: 27 for ureteral stenosis, 19 for urinary leakage. Early success was achieved in 26 patients (56.5%), including 14 ureteric stenosis (51.9%) and 12 urinary leakage (63.2%) (P=0.45). After a complementary endoscopic or surgical treatment, the final success rate was increased to 73.1% (34 patients): 20 ureteric stenosis (74.1%) and 14 urinary leakage (73.7%) (P=0.98). There were 2 graft losses (4.3%) and one death (2.2%). The mean glomerular filtration rate estimated by the MDRD was 44.58mL/min/1.73m2 (±14.7) before surgery and 45.37mL/min/1.73m2 (±16.5) 6 months after surgery (P=0.92). CONCLUSION Although frequently challenging, surgical revisions for ureteral complications after renal transplantation give good results, with a low rate of graft loss and mortality. LEVEL OF EVIDENCE 4.
Collapse
|
6
|
Lam WW, Chan T, Cheng C, Lee Y, Chau LH, Man C, Chu S. Post‐renal transplant ureterocutaneous fistula: Management of complications and literature review. Surg Pract 2019. [DOI: 10.1111/1744-1633.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Yue‐Kit Lee
- Department of SurgeryTuen Mun Hospital Hong Kong
| | | | - Chi‐Wai Man
- Department of SurgeryTuen Mun Hospital Hong Kong
| | - Sau‐Kwan Chu
- Department of SurgeryTuen Mun Hospital Hong Kong
| |
Collapse
|
7
|
Kumar V, Punatar CB, Jadhav KK, Kothari J, Joshi VS, Sagade SN, Kamat MH. Routine double-J stenting for live related donor kidney transplant recipients: It doesn't serve the purpose, but does it serve a better purpose? Investig Clin Urol 2018; 59:410-415. [PMID: 30402574 PMCID: PMC6215780 DOI: 10.4111/icu.2018.59.6.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/19/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose Despite meticulous techniques, surgical complications continue to be problematic in kidney transplant recipients. Role of routine stenting to reduce complications is controversial. In this study, we compare incidence of early urological complications, lymphoceles, urinary tract infections (UTI) and graft function; with or without double-J stenting. Materials and Methods All patients who underwent live related donor renal transplantation from February 2014 to February 2016 were included. Transplants prior to February 2015 were without routine stenting; subsequent transplants were with routine stenting. Patients with neurogenic bladder, previously operated bladder and delayed or low urinary output were excluded. Follow-up was for at least three months. Descriptive statistics was performed for all parameters. Chi square test and Fisher's Exact test were used for qualitative variables. For quantitative variables, Mann-Whitney test was used to test median difference and independent samples t-test for mean difference. The p-value ≤0.05 was considered significant. Results We analysed 74 patients (34 stented and 40 non-stented). There was no difference in the incidence of urinary leak, anastomotic obstruction, lymphoceles or UTI (p>0.4 for all comparisons). However, mean estimated glomerular filtration rate at sixth day, 14th day, one month and two months were 76.1 vs. 61.5 (p=0.025), 72.1 vs. 56.6 (p=0.005), 79.4 vs. 63.1 (p=0.002) and 82.0 vs. 63.3 (p=0.001) in the stented versus non-stented groups. Conclusions Placement of ureteral stent in renal transplant does not significantly affect the incidence of early urinary complications or UTI. However, graft function is significantly better in stented recipients, at least in the short term.
Collapse
Affiliation(s)
- Vikash Kumar
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Chirag B Punatar
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Kunal K Jadhav
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Jatin Kothari
- Department of Nephrology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Vinod S Joshi
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Sharad N Sagade
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Madhav H Kamat
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| |
Collapse
|
8
|
Buttigieg J, Agius-Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J Transplant 2018; 8:142-149. [PMID: 30211022 PMCID: PMC6134271 DOI: 10.5500/wjt.v8.i5.142] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/21/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023] Open
Abstract
Urological complications, especially urine leaks, remain the most common type of surgical complication in the early post-transplant period. Despite major advances in the field of transplantation, a small minority of kidney transplants are still being lost due to urological problems. Many of these complications can be traced back to the time of retrieval and implantation. Serial ultrasound examination of the transplanted graft in the early post-operative period is of key importance for early detection. The prognosis is generally excellent if recognized and managed in a timely fashion. The purpose of this narrative review is to discuss the different presentations, compare various ureterovesical anastomosis techniques and provide a basic overview for the management of post-transplant urological complications.
Collapse
Affiliation(s)
- Jesmar Buttigieg
- Renal Division, Mater Dei Hospital, Msida MSD2090, Malta
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | | | - Ajay Sharma
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
- Department of Transplantation, Royal Liverpool University Hospital, Liverpool L7 8XP, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3BX, United Kingdom
- Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
| |
Collapse
|
9
|
Özkaptan O, Sevinc C, Balaban M, Karadeniz T. Minimally invasive approach for the management of urological complications after renal transplantation: single center experience. MINERVA UROL NEFROL 2018; 70:422-428. [PMID: 29595043 DOI: 10.23736/s0393-2249.18.03078-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the study was to characterise urological complications after renal transplantation and to evaluate the role of minimally invasive management for urological complications. METHODS A total of 920 kidney transplantations were performed between 2008 and 2015. All patients were followed up for at least 1 year after transplantation. Complications regarded as urological were urinary leakage, ureteral stricture, urinary malignancy, bladder outlet obstruction (BOO) and urinary calculi. We evaluated data from the time of occurrence of urological complications and the type of the management prescribed. RESULTS Among 920 transplantations performed in our clinic, 41 (4.4%) urological complications arose. Twenty (48.8%) of the complications occurred during the first 3 months and 21 (51.2%) occurred after 3 months, postoperatively. Ureteral strictures were found in 14 (34.1%) patients, urinary tract stones in seven (17%), BOO in 6 (14.6%) and urinary leakage was observed in 5 (12.1%) patients. Ureteral stricture was managed with endoscopic approach in eight (61.3%) patients. Urinary tract stones and urinary leakage were managed in 7 (100%) and 4 (75%) patients with endoscopic approach. Overall 29 (70.7%) of 41 urological complications were managed with endourological approaches. CONCLUSIONS It is likely that the importance of open surgery could decrease in the future. Endoscopic management of urological complications have come to have an important role in the treatment of urological complications after transplantation.
Collapse
|
10
|
Shrestha BM. Systematic review of the negative pressure wound therapy in kidney transplant recipients. World J Transplant 2016; 6:767-773. [PMID: 28058229 PMCID: PMC5175237 DOI: 10.5500/wjt.v6.i4.767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 10/23/2016] [Accepted: 11/17/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To review negative pressure wound therapy (NPWT) as an important addition to the conventional methods of wound management.
METHODS A systematic review, performed by searching the PubMed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation (KT) patients (range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.
RESULTS No complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.
CONCLUSION Negative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.
Collapse
|
11
|
Lang E, Allaei A, Robinson L, Reid J, Zinn H. Minimally invasive radiologic techniques in the treatment of uretero-enteric fistulas. Diagn Interv Imaging 2015; 96:1153-60. [DOI: 10.1016/j.diii.2015.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 01/06/2023]
|
12
|
Harza M, Baston C, Preda A, Olaru V, Ismail G, Domnisor L, Daia D, Mitroi I, Baston MO, Sinescu I. Impact of ureteral stenting on urological complications after kidney transplantation surgery: a single-center experience. Transplant Proc 2014; 46:3459-62. [PMID: 25498072 DOI: 10.1016/j.transproceed.2014.08.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 07/16/2014] [Accepted: 08/19/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Urological complications such as ureteral strictures and ureteral leakage can affect the outcome of kidney transplantation by increasing morbidity and mortality, including graft loss. Controversy still exists regarding the role of stents in renal transplantation. The aim of this study was to evaluate the role of ureteral stenting in kidney transplantation. METHODS We performed a retrospective study on a series of 798 consecutive renal transplants performed in our center between January 1, 2004, and December 31, 2011. Ureteral stents were used in 152 cases (19.1%) of the total (stent group) and were removed 2 weeks postoperatively. Donor and recipient age, sex, type of ureteroneocystostomy, stent and non-stent patients, cold and warm ischemia time, and urological complications were analyzed. RESULTS The overall incidence of urological complications was 7.8% (62 cases). Ureteral stenosis (3.1%) and ureteral leakage (2.4%) were the most common complications; 39.7% (25 cases) of complications were recorded in the first month after transplantation. Major urological complication rate was 3.3% in the stent group compared with 8.8% in the non-stent group (P = .04). However, stent use was associated with the increase of urinary tract infections rate in the stent group (51.3%) compared with the non-stent group (17.9%) (P = .03). CONCLUSIONS In our study, the use of ureteral stents significantly decreased urological complications in kidney transplant recipients but increased the risk for development of urinary tract infections.
Collapse
|
13
|
Duty BD, Barry JM. Diagnosis and management of ureteral complications following renal transplantation. Asian J Urol 2015; 2:202-207. [PMID: 29264146 PMCID: PMC5730752 DOI: 10.1016/j.ajur.2015.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/15/2015] [Accepted: 08/07/2015] [Indexed: 12/14/2022] Open
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.
Collapse
Affiliation(s)
- Brian D Duty
- Department of Urology, Oregon Health & Science University, Portland, OR, USA
| | - John M Barry
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
14
|
Omar M, Abdulwahab-Ahmed A, El Mahdey AED. Endoscopic management of a chronic ureterocutaneous fistula using cyanoacrylic glue. Cent European J Urol 2014; 67:430-2. [PMID: 25667771 PMCID: PMC4310886 DOI: 10.5173/ceju.2014.04.art25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/08/2014] [Accepted: 09/26/2014] [Indexed: 11/22/2022] Open
Abstract
Ureterocutaneous fistula is a rare complication of renal surgery. Cyanoacrylate glue is a tissue adhesive, used primarily for the endoscopic control of bleeding from gastric varices. A female aged 33 presented to our facility with a ureterocutaneous fistula after surgery. We used a retrograde endoscopic approach for the instillation of 2 ml of sealant into the ureteral lumen to seal the ureter and fistulous tract. The fistulous opening healed spontaneously a week after the procedure, and the patient remained dry and symptom free for 5 months following the procedure. Endoscopic delivery of cyanoacrylate sealant was a feasible and effective way in treating a ureterocutaneous fistula in our patient.
Collapse
Affiliation(s)
- Mohamed Omar
- Department of Urology, Menofya University, Egypt
| | | | | |
Collapse
|
15
|
Duty BD, Conlin MJ, Fuchs EF, Barry JM. The current role of endourologic management of renal transplantation complications. Adv Urol 2013; 2013:246520. [PMID: 24023541 DOI: 10.1155/2013/246520] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 01/25/2023] Open
Abstract
Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common.
Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.
Collapse
|
16
|
Campos-Juanatey F, Ballestero-Diego R, Gutiérrez-Baños J, Hidalgo-Zabala E, Gala-Solana L, Mediavilla-Diez E. Urinary fistula repair in a renal graft through a partial nephrectomy and omentoplasty. Actas Urol Esp 2013; 37:316-20. [PMID: 23313287 DOI: 10.1016/j.acuro.2012.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 09/16/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We present the management with partial nephrectomy and interposition of the greater omentum in case of urinary fistulas in renal allograft. MATERIAL AND METHOD We present a patient with necrosis at the inferior pole of the renal graft that affected calyceal system but with pyeloureteral vascularization preserved. The patient's condition was satisfactorily managed with a partial nephrectomy of the necrotic renal segment and primary suturing of the collecting system with interposition of the greater omentum. We reviewed the cases published to date of partial nephrectomy in renal allograft, and examined their outcomes by analyzing the patient presentation, diagnostic tools, and surgical techniques used. RESULTS There are few cases in the current literature that describe conservative surgical management of urinary fistulas caused by segmental necrosis after renal transplantation. Surgical approach using partial nephrectomy in these cases produces favorable outcomes in our experience and reported cases. CONCLUSIONS Despite its obvious surgical complexity, this nephron-sparing management is feasible and should be implemented in cases where the prior renal function and the quantity of healthy parenchyma indicate a favorable subsequent evolution for the renal graft.
Collapse
|
17
|
Coccolini F, Lotti M, Manfredi R, Catena F, Vallicelli C, De Iaco PA, Da Pozzo L, Frigerio L, Ansaloni L. Ureteral stenting in cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy as a routine procedure: evidence and necessity. Urol Int 2012; 89:307-10. [PMID: 22868250 DOI: 10.1159/000339920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/28/2012] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There is a need for more exhaustive data concerning the use of prophylactic ureteral stenting for extended debulking and cytoreductive procedures in the literature. MATERIAL AND METHODS A retrospective analysis of the CARPEPACEM study protocol database was performed. The trial protocol schedules the positioning of bilateral ureteral stents before cytoreductive surgery + hyperthermic intraperitoneal chemotherapy (HIPEC). RESULTS Fifty-one operated patients: 31 (59.6%) with peritoneal dissemination from ovarian cancer, 8 (15.3%) from colorectal cancer, 4 (7.9%) from pseudomyxoma peritonei, 3 (5.7%) from gastric cancer, 2 (3.8%) from peritoneal mesothelioma, 1 (1.9%) from appendiceal cancer, 1 (1.9%) from endometrial cancer, and 1 (1.9%) from leiomyosarcoma. Mean and median peritoneal cancer index: 11 and 10 (range: 0-28). CC-score: CC-0 in 45 (86.5%) patients, CC-1 in 5 (9.6%) and CC-2 in 1 (1.9%). HIPEC was performed with platinum + taxol in 22 patients (42.3%), platinum + adriablastin in 10 (19.2%), mitomycin in 9 (17.3%), platinum + mitomycin in 7 (13.4%), platinum + doxorubicin in 2 (3.8%), and taxol + adriablastin in 1 (1.9%). Two major ureteral complications were observed (3.9%). DISCUSSION Prophylactic ureteral stenting could reduce the risk of postoperative ureteral complications without an increase in stent placement-related complications; however, a randomized clinical trial is needed.
Collapse
Affiliation(s)
- Federico Coccolini
- Department of General and Emergency Surgery, Ospedali Riuniti, Bergamo, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Torricelli FC, Piovesan AC, Antonopoulos IM, Falci R Jr, Saito FJ, Kanashiro H, Ebaid GX, Nahas WC. Caliceal-cutaneous fistula after kidney transplantation. Urology 2012; 79:e71. [PMID: 22386756 DOI: 10.1016/j.urology.2012.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/10/2012] [Accepted: 01/16/2012] [Indexed: 11/20/2022]
Abstract
Urinary fistula is a one of the most common complications after kidney transplantation. Conservative treatment with stent and Foley catheter drainage may be tried, however in some cases more invasive approach is needed. Caliceal fistula is a rare condition and the diagnosis may be missed. Here we present an interesting case of caliceal-cutaneous fistula diagnosed by computed tomography after living kidney transplantation. After failure of conservative management, the patient was successfully treated with partial nephrectomy.
Collapse
|
19
|
Mastromichalis MH, Frazzini P, Newall PM. Successful endoscopic management of a chronic transplant ureterocutaneous fistula. Urology 2011; 78:952-3. [PMID: 21840581 DOI: 10.1016/j.urology.2011.06.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/02/2011] [Accepted: 06/17/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To illustrate a minimally invasive, well-tolerated, clinically, and cost-effective method for surgically managing a high-output, transplant ureterocutaneous fistula manifesting as chronic urinary tract infection and recurrent pyelonephritis. This method will subject the immunosuppressed patient to less morbidity and minimize risk to the functioning renal graft. METHODS A combined percutaneous-endoscopic fistula closure method was developed using Deflux® to cystoscopically occlude the transplant ureteral orifice and Bioglue® to seal the ureter and fistula tract. RESULTS The patient was infection free, completely dry, and had no voiding dysfunction after undergoing this occlusion method. CONCLUSION This report demonstrates that this minimally invasive technique is a safe, well-tolerated, and effective technique that may be offered as an outpatient, first-line therapy over open or laparoscopic excision.
Collapse
Affiliation(s)
- M H Mastromichalis
- Department of Surgery, Saint Louis University Hospital, St. Louis, MO, USA.
| | | | | |
Collapse
|
20
|
Ye J, Li Q, Liu R, Zhang K, Nie Z, Chen J, Jin F, Huo W. Pedicled greater omentum graft: a new technique to repair recurrent urinary fistulae after kidney transplantation. Cell Biochem Biophys 2012; 62:69-72. [PMID: 21833672 DOI: 10.1007/s12013-011-9260-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Urinary fistula is the most frequent urologic complication within the first month after kidney transplantation, which often leads to graft loss and mortality. Open surgery is the most popular approach for the treatment of these fistulae; however, it is associated with high failure rates. Here, we present a new technique of pedicled greater omentum graft to repair recurrent urinary fistulae after kidney transplantation. We used this technique in the repair of recurrent urinary fistulae in 13 post-kidney transplant patients. All operations were successful at the first attempt, and there was no fistula recurrence. Further, no complications associated with the technique have been observed during the follow-up (1-7 years). In conclusion, the use of pedicled greater omentum graft for the repair of recurrent urinary fistulae after kidney transplantation is both effective and safe.
Collapse
|
21
|
Heap S, Mehra S, Tavakoli A, Augustine T, Riad H, Pararajasingam R. Negative pressure wound therapy used to heal complex urinary fistula wounds following renal transplantation into an ileal conduit. Am J Transplant 2010; 10:2370-3. [PMID: 20738265 DOI: 10.1111/j.1600-6143.2010.03237.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Transplantation into an ileal conduit is an established option for patients with end-stage renal failure and a nonfunctioning urinary tract. Urinary fistulae are more common following these complex transplants. Urinary fistula in this scenario can cause substantial morbidity and even result in graft loss. The management options depend on the viability of the transplant ureter, the level of local sepsis and the overall condition of the patient. Urinary diversion with a nephrostomy and ureteric stents has been described in aiding the healing of urinary leaks in renal transplants into a functioning urinary tract. We describe the successful use of negative wound pressure therapy to eradicate the local sepsis and help the healing of a recurrent urinary fistula following kidney transplantation into an ileal conduit. To our knowledge these are the first such cases reported in the literature.
Collapse
Affiliation(s)
- Sarah Heap
- The Transplant Unit, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK.
| | | | | | | | | | | |
Collapse
|