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Endourological Management of Urological Complications Following Renal Transplantation

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Difficult Cases in Endourology

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Abstract

Objectives: To discuss various endourological techniques used for treatment of urological complications after renal transplantation. Comparison between different endourological options, optimization of patient selection, and criteria of success of these minimally invasive procedures are also provided.

Materials and Methods: Database of PubMed and the Cochrane Database were searched through May 2011 without time limit. The following keywords were used: renal transplant, urological complications, urinary leakage, stricture, reflux, urolithiasis, and endoscopy. A total of 500 publications were retrieved. Relevant studies were analyzed.

Results: Major urological complications following renal transplantation are ureteral leakage and stricture resulting mainly from technical errors. Initial management of obstructed ureters by percutaneous nephrostomy tube (PCN) fixation may improve graft survival and provide better access for diagnosis and intervention. Regardless of the technique of management of ureteral stricture, postoperative ureteral stenting for 6–8 weeks is mandatory. Minimal urinary leakage is an encouraging factor for applying conservative treatment by prolonged urethral catheterization in case of vesical leakage or PCN ± ureteral stent for ureteral leakage, otherwise, early open surgical reconstruction is recommended. Endoscopic intraureteral or subureteral injection of bulking agents seems to be a plausible alternative treatment to correct posttransplant vesicoureteral reflux. Meticulous and careful trials of stone disintegration and extraction by flexible ureteroscopy should be attempted before proceeding to percutaneous nephrolithotomy.

Conclusions: A vast majority of, but not all, urological complications after renal transplantation are amenable for endourological intervention. Early diagnosis and careful patient selection for specific endourological techniques are the mainstays of a successful outcome.

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Authors and Affiliations

  1. Department of Urology, Urology and Nephrology Center, Mansoura University, El Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed S. El-Hefnawy M.D., Mohamed M. Elsaadany M.D., M.Sc., Shady A. Soliman M.D., Yasser Osman M.D., Ahmed M. Shoma M.D. & Ahmed A. Shokeir M.D., Ph.D., FEBU

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  1. Ahmed S. El-Hefnawy M.D.
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  2. Mohamed M. Elsaadany M.D., M.Sc.
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  4. Yasser Osman M.D.
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Correspondence to Ahmed A. Shokeir M.D., Ph.D., FEBU .

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Editors and Affiliations

  1. Fac. Medicine, Dept. Surgery, Kuwait University, Safat, Kuwait

    Ahmed M. Al-Kandari

  2. , Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, 387 001, India

    Mahesh Desai

  3. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed A. Shokeir

  4. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed M. Shoma

  5. , Smith Institute for Urology, Long Island Jewish Health System, New York, 11040, USA

    Arthur D. Smith

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El-Hefnawy, A.S., Elsaadany, M.M., Soliman, S.A., Osman, Y., Shoma, A.M., Shokeir, A.A. (2013). Endourological Management of Urological Complications Following Renal Transplantation. In: Al-Kandari, A., Desai, M., Shokeir, A., Shoma, A., Smith, A. (eds) Difficult Cases in Endourology. Springer, London. https://doi.org/10.1007/978-1-84882-083-8_18

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