Surgical treatment of urologic complications in kidney transplantation

Between January 1973 and December 1987 we carried out 846 kidney transplants using a transvesical end-to-side implantation of the ureter in the bladder without an antireflux mechanism. Moreover, 22 transplantations were carried out in 19 patients with a urinary diversion. We examined the urologic complications in these 868 consecutive transplants. Urinary leakage and obstruction were the two main urologic posttransplant complications. Severe leakage occurred in 17 patients (1.9%) and was treated by open surgery; the treatment of choice is a pyeloureterostomy (anastomosis between the transplant renal pelvis and the native ureter). There were 33 patients (3.8%) with severe ureteral obstructions. In 28 patients, open surgical treatment of the obstruction was necessary, and 5 patients required percutaneous endourologic treatment (dilitation of a confined ureteral stricture in 4 patients and percutaneous stone treatment in 1). The postoperative mortality was low: three patients (6%) died, two of septicemia due to leakage and one of pulmonary embolism after repair of the obstruction. The results of surgical treatment were good. The graft survival after 2 years in the group of urologically complicated transplants was 69.2% for the patients with leakage and 82.4% for those with obstructions. We conclude from these results that urologic complications after renal transplantation can be successfully treated by surgical (or percutaneous) correction.