Management of ureteral complications in renal transplantation: prevention and treatment

Urinary anastomotic complications following renal transplantation cause significant patient morbidity. In ureteric reconstruction, different techniques are used to reduce complications (such as leakage or obstruction). In this study, we suggested two aspects of management of the complications of ureteral anastamosis: ureteral spatulation more than 10 mm for prevention and percutaneous nephrostomy and balloon dilatation as the first steps of treatment. A sequential double-blind random trial with 170 kidney transplant recipients was performed, dividing the patients into two groups: group 1 patients had ureteral spatulation length ≤ 10 mm (70 recipients) and group 2 patients had ureteral spatulation ≥ 10 mm (100 recipients). In patients with ureteral stenosis, percutaneous nephrostomy (PCN) and balloon dilatation were used as the first step of treatment. The mean age was 44 ± 4.2 years. Before and after removing the double J stent, ureteral complications that needed surgical intervention occurred in 16/70 recipients in group 1 (20.3%) and in eight/100 recipients in group 2 (8%). There is a significant difference between the two groups (P < 0.05). PCN and balloon dilatation were performed in 24 patients with ureteral stenosis. Eleven patients had a good response and 13 patients underwent surgical procedures (in four of theses patients, ileal interposition was used for repairing the ureteral defects). In conclusion, ureteral spatulation more than 10 mm in prevention of ureteral stenosis and use of PCN and balloon dilatation in the first step of treatment of ureteral obstruction should be the management choice for these patients.