Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years

Introduction: This study is a retrospective analysis of ureteral complications and their management from a monocenter series of 277 consecutive renal transplantations. Materials and Methods: From September 1979 to June 1999, 277 renal transplantations (cadaveric origin) were performed in 241 patient...

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Veröffentlicht in:Urologia internationalis 2005-01, Vol.75 (2), p.144-149
Hauptverfasser: Praz, V., Leisinger, H.-J., Pascual, M., Jichlinski, P.
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creator Praz, V.
Leisinger, H.-J.
Pascual, M.
Jichlinski, P.
description Introduction: This study is a retrospective analysis of ureteral complications and their management from a monocenter series of 277 consecutive renal transplantations. Materials and Methods: From September 1979 to June 1999, 277 renal transplantations (cadaveric origin) were performed in 241 patients. The ureter from the kidney graft was inserted into the bladder according to the technique of extravesical implantation described by Lich-Gregoir and Campos-Freire. The study analyzed the time of occurrence and the type of complications observed. The different procedures to restore the transplanted urinary tract are presented. Results: Complications occurred in 43/277 renal transplantations (15.5%). Anastomotic urine leakage or ureteral stricture were the most frequent. The time to appearance of these complications was either short (1 month) in a similar number of cases. Most cases were managed surgically: 33/43 cases (76.7%). The most frequent surgical repair was ureterovesical reimplantation (n = 13), followed by: ureteroureteral end-to-end anastomosis (native ureter–ureter transplant, n = 5); pyeloureteral anastomosis (native ureter–renal pelvis transplant, n = 5); simple revision of ureterovesical implantation (n = 4); resection and end-to-end anastomosis of the transplant ureter (n = 2); calico-vesicostomy (graft-bladder, n = 1); implantation according to Boari (n = 1); pyelovesicostomy with bipartition of bladder (n = 1), and pyeloileocystoplasty with detubularized ileal graft (n = 1). No deaths related to any of the urological complications were reported. However, 2 consecutive vesico-renal refluxes led to the loss of the kidney graft in the long-term. Conclusion: The rate of complications observed in this retrospective analysis is similar to the experience of other studies, ranging from 2 to 20%. If the classical extravesical ureteral bladder implantation is to remain an attractive technique due to its simplicity, the surgical team at the training center should be aware of all the means to prevent any ureteral complications, such as the choice of another implantation technique and/or insertion of a transient ureteral stent.
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Materials and Methods: From September 1979 to June 1999, 277 renal transplantations (cadaveric origin) were performed in 241 patients. The ureter from the kidney graft was inserted into the bladder according to the technique of extravesical implantation described by Lich-Gregoir and Campos-Freire. The study analyzed the time of occurrence and the type of complications observed. The different procedures to restore the transplanted urinary tract are presented. Results: Complications occurred in 43/277 renal transplantations (15.5%). Anastomotic urine leakage or ureteral stricture were the most frequent. The time to appearance of these complications was either short (&lt;1 month) or late (&gt;1 month) in a similar number of cases. Most cases were managed surgically: 33/43 cases (76.7%). The most frequent surgical repair was ureterovesical reimplantation (n = 13), followed by: ureteroureteral end-to-end anastomosis (native ureter–ureter transplant, n = 5); pyeloureteral anastomosis (native ureter–renal pelvis transplant, n = 5); simple revision of ureterovesical implantation (n = 4); resection and end-to-end anastomosis of the transplant ureter (n = 2); calico-vesicostomy (graft-bladder, n = 1); implantation according to Boari (n = 1); pyelovesicostomy with bipartition of bladder (n = 1), and pyeloileocystoplasty with detubularized ileal graft (n = 1). No deaths related to any of the urological complications were reported. However, 2 consecutive vesico-renal refluxes led to the loss of the kidney graft in the long-term. Conclusion: The rate of complications observed in this retrospective analysis is similar to the experience of other studies, ranging from 2 to 20%. If the classical extravesical ureteral bladder implantation is to remain an attractive technique due to its simplicity, the surgical team at the training center should be aware of all the means to prevent any ureteral complications, such as the choice of another implantation technique and/or insertion of a transient ureteral stent.</description><identifier>ISSN: 0042-1138</identifier><identifier>EISSN: 1423-0399</identifier><identifier>DOI: 10.1159/000087169</identifier><identifier>PMID: 16123569</identifier><language>eng</language><publisher>Basel, Switzerland</publisher><subject>Adolescent ; Adult ; Age Distribution ; Aged ; Cadaver ; Cohort Studies ; Female ; Humans ; Incidence ; Kidney Failure, Chronic - diagnosis ; Kidney Failure, Chronic - surgery ; Kidney Transplantation - adverse effects ; Kidney Transplantation - methods ; Male ; Middle Aged ; Original Paper ; Prognosis ; Retrospective Studies ; Risk Assessment ; Sex Distribution ; Switzerland - epidemiology ; Tissue Donors ; Ureteral Calculi - epidemiology ; Ureteral Calculi - etiology ; Ureteral Calculi - physiopathology ; Ureteral Obstruction - epidemiology ; Ureteral Obstruction - etiology ; Ureteral Obstruction - physiopathology ; Urologic Diseases - epidemiology ; Urologic Diseases - etiology ; Urologic Diseases - physiopathology ; Vesico-Ureteral Reflux - epidemiology ; Vesico-Ureteral Reflux - etiology ; Vesico-Ureteral Reflux - physiopathology</subject><ispartof>Urologia internationalis, 2005-01, Vol.75 (2), p.144-149</ispartof><rights>2005 S. 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Materials and Methods: From September 1979 to June 1999, 277 renal transplantations (cadaveric origin) were performed in 241 patients. The ureter from the kidney graft was inserted into the bladder according to the technique of extravesical implantation described by Lich-Gregoir and Campos-Freire. The study analyzed the time of occurrence and the type of complications observed. The different procedures to restore the transplanted urinary tract are presented. Results: Complications occurred in 43/277 renal transplantations (15.5%). Anastomotic urine leakage or ureteral stricture were the most frequent. The time to appearance of these complications was either short (&lt;1 month) or late (&gt;1 month) in a similar number of cases. Most cases were managed surgically: 33/43 cases (76.7%). The most frequent surgical repair was ureterovesical reimplantation (n = 13), followed by: ureteroureteral end-to-end anastomosis (native ureter–ureter transplant, n = 5); pyeloureteral anastomosis (native ureter–renal pelvis transplant, n = 5); simple revision of ureterovesical implantation (n = 4); resection and end-to-end anastomosis of the transplant ureter (n = 2); calico-vesicostomy (graft-bladder, n = 1); implantation according to Boari (n = 1); pyelovesicostomy with bipartition of bladder (n = 1), and pyeloileocystoplasty with detubularized ileal graft (n = 1). No deaths related to any of the urological complications were reported. However, 2 consecutive vesico-renal refluxes led to the loss of the kidney graft in the long-term. Conclusion: The rate of complications observed in this retrospective analysis is similar to the experience of other studies, ranging from 2 to 20%. If the classical extravesical ureteral bladder implantation is to remain an attractive technique due to its simplicity, the surgical team at the training center should be aware of all the means to prevent any ureteral complications, such as the choice of another implantation technique and/or insertion of a transient ureteral stent.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Distribution</subject><subject>Aged</subject><subject>Cadaver</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kidney Failure, Chronic - diagnosis</subject><subject>Kidney Failure, Chronic - surgery</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Paper</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sex Distribution</subject><subject>Switzerland - epidemiology</subject><subject>Tissue Donors</subject><subject>Ureteral Calculi - epidemiology</subject><subject>Ureteral Calculi - etiology</subject><subject>Ureteral Calculi - physiopathology</subject><subject>Ureteral Obstruction - epidemiology</subject><subject>Ureteral Obstruction - etiology</subject><subject>Ureteral Obstruction - physiopathology</subject><subject>Urologic Diseases - epidemiology</subject><subject>Urologic Diseases - etiology</subject><subject>Urologic Diseases - physiopathology</subject><subject>Vesico-Ureteral Reflux - epidemiology</subject><subject>Vesico-Ureteral Reflux - etiology</subject><subject>Vesico-Ureteral Reflux - physiopathology</subject><issn>0042-1138</issn><issn>1423-0399</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1Lw0AQhhdRbK0ePAuyJ8FDdD-ySdZbiVqFgiDtwVOYJLtlNcnG3bTQf-9qS53LDDPPvMy8CF1SckepkPckRJbSRB6hMY0ZjwiX8hiNCYlZRCnPRujM-09CAizTUzSiCWVcJHKM_NLZxq5MBQ3Obds3oRqM7Tw2HX5XXWgvHHS-b6Ab_iZYO9viHGrYKGcq_Gg76_DMgR78A56GpcFZ36tqMBuFp0Fh643HVmNG8IcC58_RiYbGq4t9nqDl89Mif4nmb7PXfDqPKk74EEEC4Rcp45LJJK5oCUnNKp6lss4Ip0xpzhhJIdWyJpBCHEshdCoBapGUccYn6Gan2zv7vVZ-KFrjK9WEV5Rd-yLJBKMiFQG83YFVuNw7pYvemRbctqCk-HW4ODgc2Ou96LpsVf1P7i0NwNUO-AK3Uu4A7NZ_AMZxfrg</recordid><startdate>20050101</startdate><enddate>20050101</enddate><creator>Praz, V.</creator><creator>Leisinger, H.-J.</creator><creator>Pascual, M.</creator><creator>Jichlinski, P.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050101</creationdate><title>Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years</title><author>Praz, V. ; Leisinger, H.-J. ; Pascual, M. ; Jichlinski, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c303t-a6a423994b2964c1ba6d2c3879d80312ef32207a7f9d0a7a44955f79aad56b483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Distribution</topic><topic>Aged</topic><topic>Cadaver</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kidney Failure, Chronic - diagnosis</topic><topic>Kidney Failure, Chronic - surgery</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Paper</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sex Distribution</topic><topic>Switzerland - epidemiology</topic><topic>Tissue Donors</topic><topic>Ureteral Calculi - epidemiology</topic><topic>Ureteral Calculi - etiology</topic><topic>Ureteral Calculi - physiopathology</topic><topic>Ureteral Obstruction - epidemiology</topic><topic>Ureteral Obstruction - etiology</topic><topic>Ureteral Obstruction - physiopathology</topic><topic>Urologic Diseases - epidemiology</topic><topic>Urologic Diseases - etiology</topic><topic>Urologic Diseases - physiopathology</topic><topic>Vesico-Ureteral Reflux - epidemiology</topic><topic>Vesico-Ureteral Reflux - etiology</topic><topic>Vesico-Ureteral Reflux - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Praz, V.</creatorcontrib><creatorcontrib>Leisinger, H.-J.</creatorcontrib><creatorcontrib>Pascual, M.</creatorcontrib><creatorcontrib>Jichlinski, P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urologia internationalis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Praz, V.</au><au>Leisinger, H.-J.</au><au>Pascual, M.</au><au>Jichlinski, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years</atitle><jtitle>Urologia internationalis</jtitle><addtitle>Urol Int</addtitle><date>2005-01-01</date><risdate>2005</risdate><volume>75</volume><issue>2</issue><spage>144</spage><epage>149</epage><pages>144-149</pages><issn>0042-1138</issn><eissn>1423-0399</eissn><abstract>Introduction: This study is a retrospective analysis of ureteral complications and their management from a monocenter series of 277 consecutive renal transplantations. Materials and Methods: From September 1979 to June 1999, 277 renal transplantations (cadaveric origin) were performed in 241 patients. The ureter from the kidney graft was inserted into the bladder according to the technique of extravesical implantation described by Lich-Gregoir and Campos-Freire. The study analyzed the time of occurrence and the type of complications observed. The different procedures to restore the transplanted urinary tract are presented. Results: Complications occurred in 43/277 renal transplantations (15.5%). Anastomotic urine leakage or ureteral stricture were the most frequent. The time to appearance of these complications was either short (&lt;1 month) or late (&gt;1 month) in a similar number of cases. Most cases were managed surgically: 33/43 cases (76.7%). The most frequent surgical repair was ureterovesical reimplantation (n = 13), followed by: ureteroureteral end-to-end anastomosis (native ureter–ureter transplant, n = 5); pyeloureteral anastomosis (native ureter–renal pelvis transplant, n = 5); simple revision of ureterovesical implantation (n = 4); resection and end-to-end anastomosis of the transplant ureter (n = 2); calico-vesicostomy (graft-bladder, n = 1); implantation according to Boari (n = 1); pyelovesicostomy with bipartition of bladder (n = 1), and pyeloileocystoplasty with detubularized ileal graft (n = 1). No deaths related to any of the urological complications were reported. However, 2 consecutive vesico-renal refluxes led to the loss of the kidney graft in the long-term. Conclusion: The rate of complications observed in this retrospective analysis is similar to the experience of other studies, ranging from 2 to 20%. If the classical extravesical ureteral bladder implantation is to remain an attractive technique due to its simplicity, the surgical team at the training center should be aware of all the means to prevent any ureteral complications, such as the choice of another implantation technique and/or insertion of a transient ureteral stent.</abstract><cop>Basel, Switzerland</cop><pmid>16123569</pmid><doi>10.1159/000087169</doi><tpages>6</tpages></addata></record>
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source MEDLINE; Karger Journals
subjects Adolescent
Adult
Age Distribution
Aged
Cadaver
Cohort Studies
Female
Humans
Incidence
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - surgery
Kidney Transplantation - adverse effects
Kidney Transplantation - methods
Male
Middle Aged
Original Paper
Prognosis
Retrospective Studies
Risk Assessment
Sex Distribution
Switzerland - epidemiology
Tissue Donors
Ureteral Calculi - epidemiology
Ureteral Calculi - etiology
Ureteral Calculi - physiopathology
Ureteral Obstruction - epidemiology
Ureteral Obstruction - etiology
Ureteral Obstruction - physiopathology
Urologic Diseases - epidemiology
Urologic Diseases - etiology
Urologic Diseases - physiopathology
Vesico-Ureteral Reflux - epidemiology
Vesico-Ureteral Reflux - etiology
Vesico-Ureteral Reflux - physiopathology
title Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years
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