role of ureteroscopy in the treatment of renal transplantation complications

To determine the feasibility, safety, and efficacy of diagnostic and therapeutic ureteroscopy in renal allograft ureters. We reviewed 1560 consecutive renal allografts have been preformed between June 1989 and February 2002. Twenty-eight patients [1.8%] had indication for endoscopic procedure on allograft ureter. Six patients had obstructive ureteral calculi with a history of failed ESWL, 3 had suspected ureteral stricture, 9 had upward migrated ureteral stents and 10 had ureteral stricture at ureteroneocystostomy site. Ureters were anastomosed to bladder using Leadbetter- Politano and Lich-GreGoire methods in 6 and 22 cases, respectively. Ureteroscopies were performed with semi rigid 9.8F wolf ureteroscope. Identifying and introducing the ureteral orifice was successful in 19 [68%] cases. If we exclude 10 patients with ureteral stricture, ureteroscopy was successful in 13 out of 18 [72%]. Four ureteral calculi [67%] were removed with ureteroscope.Seven out of nine migrated stents [78%] were retrieved. Four patients with ureteral stricture at ureteroneocystostomy site [40%] had successful ureteral dilatation and double J ureteral catheters were also inserted. Diagnostic ureteroscopy was successful in all cases. Two complications including one urinary leakage and one symptomatic urinary tract infection occurred that were managed conservatively. Ureteral endoscopy was safe and effective method for management of urological complications after RT [renal transplantation]. This procedure can be considered as the first choice compared with percutaneous and antegrade modalities

comparison of augmentation cystoplasty before and after renal transplantation with the control group

We compared two surgical methods of augmentation cystoplasty [AC], before and after renal transplantation, and the outcomes of both methods with transplant patients with normal bladder function. 1520 kidney transplantations were performed at Shahid Labbafinejad Center between March 1988 and February 2002 of which 36 cases was accompanied with AC. In 20 patients [group A] AC was performed before transplantation. This group consisted of 14 males and 6 females with a mean age of 26.1 [13-39] at the time of transplantation. Sixteen patients consisting of 11 males and 5 females [mean age 27.3, 12-44] underwent AC after transplantation. Eventually 40 transplant patients with normal bladder function were assigned in the control group including 18 males and 22 females with a mean age of 31.2 [11-55] [group C]. Normal graft function was achieved in 16, 13, and 33 patients of groups A, B, and C respectively over the mean follow-up of 70, 59, and 76 months [p<0.7]. Mean serum creatinine during the follow-up was 1.48 +/- 0.4, 1.7 +/- 1, and 1.4 +/- 0.55 for groups A, B, and C respectively. 9, 12, and 17 patients [26, 64, and 34 cases] with UTI requiring hospital admission were observed in the 3 groups respectively. The incident of UTI and the resultant hospitalization in group B was more than the one in group C [p<0.03], but it did not differ significantly from group A to group C. AC is a safe and effective method to improve the lower urinary system function and with the exception of increased risk of UTI following AC after transplantation [group B], there is no considerable difference in the complication rates between AC before and after renal transplantation. As a result, we can perform AC before or after kidney transplantation in patients with dysfunctional lower urinary tract system up to their specific conditions