ABSTRACT
Extensive ureteral stricture (EUS) after renal transplantation (RTx) is an important urological complication that adversely affects the longterm function of the allograft and therefore the morbidity and mortality of the recipients. We conducted this study to determine the prevalence of the EUS in RTx recipients and its impact on the patient and graft survival. We assessed retrospectively, 1450 patients who underwent renal transplantation by a fixed surgical team between December 1991 and December 2009 at Emam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran. EUS was diagnosed in 13 (1.1%) patients including 8 (61.5%) male. The mean±SD age of patients at the time of surgery was 33.6±13.7 years; the length of follow-up was 77.9±63.5 months; and the ischemic time was 126.5±114.1 min. Mostly, EUS was noticed in recipients of transplants with more than one artery (p<0.05) and of cadaveric donors with more than 4 hour ischemic time (p<0.001). In follow-up, after ureteropyelostomy (7 cases), ipsilateral pyelopyloplasty (4 cases) and contralateral pyelopyeloplasty (2 cases), no evidence of ureteral stricture recurrence, graft loss or death was observed. We concluded that the incidence of EUS, as a urologic complication after RTx is very low. The advanced techniques of RTx that preserve the ureteric blood supply and the better procedures for ureteral reconstruction have improved the survival rate of patient and graft.
ABSTRACT
BACKGROUND: Augmentation cystoplasty before or after renal transplantation is an option for patients with end-stage renal disease who are candidates for renal transplantation and have low capacity and poorly compliant bladders. OBJECTIVE: To compare two surgical methods of bladder augmentation-enterocystoplasty (EC) and ureterocystoplasty (UC)-before kidney transplantation, and their outcome with that in kidney recipients who had normal bladder function. METHODS: During a 20-year period (1988-2008), 1406 renal transplantation were performed in our center by our team. In 16 patients having a mean age of 18.8 years, EC (group A) and in 8 with mean age of 11.5 years, UC (group B) were performed before renal transplantation. These two groups were compared with a control group of 30 recipients with normal bladder (group C) with mean age of 15.6 years, for kidney function, graft and patient survival, and the frequency of urinary tract infection (UTI). RESULTS: There was normal graft function in 11 of group A, 7 of group B, and 24 of group C patients, during a mean follow-up of 73.1 months. The mean±SD serum creatinine in follow-up was 1.72±0.31, 1.37±0.13 and 1.33±0.59 mg/dL in groups A, B and C, respectively. No statistically significant differences were observed among the 3 studied groups in terms of 1-, 5- and 10-year graft and patient survivals. Number of episodes of febrile UTI requiring hospitalization was 23, 6 and 2 in groups A, B and C, respectively. UTI and urosepsis were significantly more frequent in group A than groups B (p=0.025) and C (p=0.001); no significant difference was observed in the frequency between groups B and C (p=0.310). CONCLUSION: Both EC and UC are equally recommended before renal transplantation for reconstruction of the lower urinary tract; use of each method should be individualized depending on specific conditions of recipient.
