Strategy of differently located urinary fistulae after kidney transplantation / 重庆医科大学学报

ABSTRACT

Objective:We summarized the therapeutic results of 68 differently located urinary fistulae after kidney transplantation in order to approach optimal treatments for them. Methods: Between December 1994 and July 2008, fistulae were observed in 68 of 1263 patients (5.4%) after kidney transplantation,including 26 lower fistulae and 42 upper fistulae. The former included vesical fistulae and stoma fistulae,while the latter included ureter fistulae,pelvis fistulae.The location of fistulae was determined by cystography, magnetic resonance hydrography(MRH) or operation research. In both groups we first adopted conservative treatment which was placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in,however,if invalid,we resorted to surgical repair. Subsequently, therapeutic efficacies of differently located fistulae observed. Results: Twenty of 26 lower fistulae(76.9%) were cured successfully by conservative treatment For the remaining 6 cases(23.1%),we had to turn to open surgery, among which 5 were cured and 1 underwent nephrectomy because of acute rejection. Only 8 of 42 upper fistula(19.0%)were cured by conservative treatment, but the other 34(81.0%)cases accepted open surgery among which 29 were cured, and 3 underwent nephrectomy owing to acute rejection (1 case)and failure of surgery(2 cases), and 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae(76.9% vs. 19.0%,P