Surgical treatment choices in urethral complications following renal transplantations

Ureteral stenosis and necrosis are the most common urological complications after renal transplantation. Surgery is the treatment of choice in ureter necrosis, whereas surgery, percutaneous approachments and laser endoureteromy may be applied in ureter stenosis. The aim of this study is to review the reasons and surgical treatment methods of ureteral complications following renal transplantations that were performed in our center. The medical records of 160 patients who underwent cadaver or living donor renal transplantation between 2011 and 2014 were retrospectively evaluated from the hospital medical record network system. Patients who were operated because of ureteral complications were enrolled to the study. Six patients (3, 75%) had ureter stenosis, and 4 patients (2, 5%) had ureter necrosis. Three of these transplantations were made from living donors (2 females and 1 male) and 7 were from cadavers (1 female and 6 males). Extravasation was found in 4 patients due to necrosis, all encountered in second week of operation. Two patients underwent native ureteropyelostomy and two others underwent ureteroneocystostomy for ureter necrosis. One patient underwent ureteroureterostomy, four had ureteroneocystostomy, and one had native ureteropyelostomy for stenosis. One patient had postoperative urine leak who underwent native ureteropelvic anastomosis. Male cadaver donor, transplantation from cadaver, delayed graft function, long duration of cold ischemia seem to be the risk factors for ureteral complications following renal transplantation. Ureteroneocystostomy and native ureteropyelostomy are safe and efficient surgery methods. The treatment method must be established according to patient and reason of disease.