RESULTS OF URETEROPYELOSTOMY WITH USING THE RECIPIENT’S URETER IN MANAGING URETERAL COMPLICATION AFTER RENAL TRANSPLANTATION.

Urologic complications occur in 1% to 30% of patients in different series. These complications are ureteral necrosis and stricture, urinary leakage, renal pelvis necrosis, ureterovesical stenosis and symptomatic ureterovesical reflux. Ureteropyelostomy with using the recipient’s ureter is one of options for management of ureteral complication after renal transplantation. We present our experience in managing ureteral complication after renal transplantation in 7 patients through performance of ureteropyelostomy using the recipient’s ureter.

Materials & Methods: from Feb 2005 to Feb 2005, 128 renal grafts were performed at our hospital. An exteravesical reimplantation technique (barry or barry_tagochi ureterovesical anastomosis) was used. Ureteropyelostomy using the recipient’s own ipsilateral ureter were performed in 7 cases. Mean time between transplantation and ureteropyelostomy, kidneys sonography and Cr before and after surgery, leakage, flank pain, fever, symptomatic UTI, and history of failed operation were reviewed.

Results: Imaging shows uvj stenosis in 4 patiants, ureteral necrosis in 2 case, and upj obstruction in1 case. Mean time between transplantation and ureteropyelostomy was 72 days. Mean Cr before and after surgery was 4.4 and 2.2 respectively. Comparison of graft sonography before and 1 month after the surgery showed improvement of hydronephrosis in 6 patiants and its diminishing in 1 case. In native kidney no new hydronephrosis was shown. None of the patient had flank pain, leakage, and wound infection. Symptomatic UTI was seen in 1case that improved with medical therapy. Pyonephrosis with fever occurred in 1 patiant who had sever hydronephrosis in native kidney before surgery.

Conclusion: Ureteropyelostomy with using the recipient’s native ureter is a safe and effective treatment for management of ureteral complication after renal transplantation.