Management of urological complications and diseases in renal transplant recipients [Böbrek Nakli Alicilarinda Görülen İstenmeyen Ürolojik Yan Etkiler ve Hastaliklarin Tedavisi]
Introduction: Although rarely life-threatening, urological complications are associated with significant morbidity in the immunosuppressed patient and ultimately may be associated with long-term allograft dysfunction and loss. Urological complications of renal transplantation are relatively uncommon although the incidence differs among various. Herein therapies for urological diseases and complications which occured in renal transplant recipients were evaluated retrospectively. Materials and methods: Between 1989 and 2004, 242 consecutive renal transplantations were performed at our center. Patterns and incidence of urological complications and therapies which were applied for these complications were investigated in these cases. The data were collected from file enrollment of patients and compared with the findings reported in the literature. No change was done in immunosuppressive protocols. Antibiotic therapy was started preoperatively and was continued according to the urine cultures and antibiograms postoperatively. Complications in the posttransplantation period such as urine leakage from ureterovesical junction, necrosis of the distal ureter, stenosis of the ureterovesical junction and lymphocele were interfered by either endoscopical or open surgical techniques under general anesthesia. Results: Between 1989 and 2004, 57 urological interferences were applied to 46 renal transplant recipients (28 male and 18 female). The mean age of recipients was 35 years (range 9-67 years). Thirty two of these patients underwent renal transplantation in our center and the others (14 patients) underwent out of our center. Twenty four operations applied for complications were performed in the posttransplantation first month. When the interference were applied, graft age ranged between 1 day and 120 months (mean 14.4±27.1). Urological complications were detected in 32 of 242 patients (13.2%), including 10 urinary fistula (4.1%) (with 1 distal ureteral necrosis), 3 ureteric stenosis (1.2%), 1 renal calculus (0.4%), 1 bladder calculus (0.8%) 15 graft nephrectomy (due to acute and chronic rejection), 3 clinically significant renal arterial stenosis (1.2%) and 8 lymphocele requiring intervention. Renal allograft rupture due to accelerated rejection was developed in one pediatric case. Conclusion: Urological complications constitute significant problems following renal transplantation. The most important aspects concerning these complications are early diagnosis and prompt treatment. Delay in diagnosis and management may lead to deterioration of renal graft function or graft loss. Most common complications seen after renal transplantations are ureterovesical fistula, ureterovesical stenosis and lymphocele formation. All urological interventions were successful if the graft nephrectomies were ignored. This shows that endoscopical and open surgical methods can be performed successfully for the therapy of urological problems occurring in patients with renal transplantation and these methods result in success. We did not find any relationship between the appearance of urological complications and the graft survival
