Urological complications after kidney transplantation

Česká verzia

Authors: Ján Breza ml. ^1,2; Róbert Fröhlich ¹; Zuzana Žilinská ¹; Ján Breza st. ¹
Authors place of work: Urologická klinika s Centrom pre transplantácie obličiek Lekárskej fakulty Univerzity Komenského a Univerzitnej nemocnice Bratislava ¹; Klinika pediatrickej urológie, Národný ústav detských chorôb, Bratislava ²
Published in the journal: Ces Urol 2019; 23(3): 203-220
Category: Review article

Summary

The aim of our work was to analyze urological complications after kidney transplantation at the Urology Department with the Center for Kidney Transplantation in Bratislava and to provide rational guidance for their effective solution.

The authors analyzed complications in a group of 1353 renal transplant patients (of which 95 kidneys were retrieved from living donors). We focused on the occurrence, causes, diagnosis and treatment of complications that have a causal relationship to the reconstructed kidney transplant pathways because they are considered to be the most serious complications after kidney transplantation. They account for about 50% of all surgical complications, may cause significant morbidity and mortality, may lead to a delayed onset of the function as well as to the loss of the transplanted kidney. They may even endanger the patient’s life.

The outcome of kidney transplantation and of the occurrence of urological complications is significantly influenced by the surgical technique of kidney removal and transplantation and by the reconstruction of the urinary tract. During kidney removal, all nerves innervating the kidney are disrupted. In terms of glomerular and tubular function of the kidney, denervation is insignificant and does not adversely affect the transport role of the upper urinary tract. However, denervation of the kidney may change the symptomatology of some diseases or of the post-transplant complications. The transplanted kidney does not hurt, hence the patients do not seek help in time and the diagnostics of complications after kidney transplantation is more demanding and often delayed.

In the form of a review article, the authors offer their experience with the diagnostics and treatment of urological complications after kidney transplantation to the readers of the Czech Urology magazine. The algorithms arise from the authors‘ own clinical experience in renal transplantation at the Department of Urology in Bratislava and express a rational approach to the diagnostics and treatment of urological complications following kidney transplantation.

Keywords:

Renal transplantation – urological complications – treatment algorithms – diagnostic algorithms.

Zdroje

1. Navrátil P. Praktická urologie u nemocných v dialyzační léčbě, před a po transplantaci ledviny. Hradec Králové, vyd. Olga Čermáková, 2005; 199.

2. Kuss R, Bourget P. An illustrated history of organ transplantation. The great advanture of the century. Laboratoires Sandoz, Rueil-Malmaison, France, 1982; 175.

3. Zvara V, Řezníček J. Možnosti aktívnej liečby terminálneho štádia chronickej nedostatočnosti obličiek chronickou hemodialýzou a transplantáciou obličky. Lek. Obzor 1973; 22: 489–495.

4. Breza J ml, Brutenič J, Žilinská Z, et al. Nízko-kapacitný močový mechúr a jeho rehabilitácia po transplantácii obličky. Poster P. 11. Orgánové transplantácie 4, 2008; 1: 23.

5. Breza J, ml, Žilinská Z, Bujdák P, Breza J st. Urologické komplikácie po transplantácii obličky. Urol. Listy 7, 2009; 1: 38–48.

6. Žilinská Z, BrezaJ ml, Sersenová M, et al. Skorá diagnostika a liečba cievnych komplikácií po transplantácii obličky. Lek. Obzor 2018; 67(2): 57–62.

7. Breza J jr. Algoritmy diagnostiky a liečby urologických komplikácií po transplantácii obličky. S 17–22 v zborníku Symposium Urologie Transplantace / Transplantace Urologie. Urologické aspekty transplantace ledviny I. Hradec Králové, 3. 10. 2013.

8. Breza J ml. Algoritmy diagnostiky a liečby urologických komplikácií po transplantácii obličky. Súč Klin Prax 2015, 1: 1–5.

9. Breza J ml, Žilinská Z. Chirurgické komplikácie po transplantácii obličky. Kapitola 14. 33. 3: 130–145. In: Princípy chirurgie IV. Edited by Breza, J. a spol., Slovak Academic Press, Bratislava, 2015, 1297.

10. Breza J ml, Žilinská Z, Sersenová M, et al. Diagnostika a liečba urologických komplikácií po transplantácii obličky. Lek. Obzor (Med Horizon) 2018; 67(1): 19–24.

11. Breza J jr, Zilinska Z, Bujdak P, Breza J sr. The ureter in patients after kidney transplantation ABSTRACT C 61, Eur. Urol. Suppl., 2009; 8: 678.

12. Breza J ml, Žilinská Z, Chrastina M, Breza J st. Lymfokéla po transplantácii obličky. Lek. Obzor 61, 2012; 6: 197–203.

13. Fuller TF, Kang SM, et al. Management of lymphoceles after renal transplantation. J. Urol. 2003; 169: 2022–2025.

14. Hulgoll AK, Sundar S, Karunagaran SG, et al. Lymphoceles and their management in renal transplantation. Transplant. Proc. 2003; 25: 323–325.

15. Tondolo V, Citterio F, Massa A, et al. Lymphocele after remal transplantation: The influence of the immunosuppressive therapy. Transplant. Proc. 2006; 38: 1051–1052.

16. Iwan-Zietek I, Yietek Z, Sulikowski T, et al. Minimally invasive methods for the treatment of lymphocele after kidney transplantation. Transplant. Proc. 2009; 41: 3073–3076.

17. Hamza A, Fischer K, Koch E, et al. Diagnostics and therapy of lymphoceles after kidney transplantation. Transplant. Proc. 2006; 38: 701–706.

18. Breza J ml, Žilinská Z, Chrastina M, et al. Močovod pri transplantácii obličky. Klin. Urol. 7, 2011, č. 1, s. 15–21.

19. Kolombo, Hanuš T. Chirurgická anatomie retroperitonea 3–12. In: Hanuš T, Novák K. et al. Nemoci močovodu. Praha, Galen, 2008; 170.

20. Alcaraz A, Bujons A, Pascual X, et al. Percutaneous management of transplant ureteral fistulae is feasible in selected cases. Transplant. Proc. 2005; 37: 2111–2114.

21. Faenza A, Nardo B, Fuga G, et al.Urological complications in kidney transplantation: ureterocystostomy versus uretero-ureterostomy. Transplant. Proc. 2005; 37: 2518–2520.

22. Dalgic A, Boyval F, Karakayali H, et al. Urologic complications in 1523 renal transplantations. The Baskent University experience. Transplant. Proc. 2006; 38: 542–547.

23. Davari H, Yarmohammadi H, Malekhosseini SA, et al. Urological complications in 980 consecutive patients with renal transplantation. Int. J. Urol. 2006; 13: 1271–1275.

24. Karam G, Maillet F, Parant S, Soulillou JP, Giral-Classe M. Ureteral necrosis after kidney transplantation: risk factors and impact on graft and patient survival. Transplantation 2004; 78: 725–729.

25. Figueiredo AJ, Cunha MX, Mota AF, Furtado AL. Ureteris lesions detected in normally functioning kidney allografts: risk factors and clinical implications. Transplant. Proc. 2005; 37: 2752–2754.

26. Breza J, Řezníček J, Polák V, Zvara V. Antegrádna pyeloureterografia transplantovanej o bličky. Brat. Lek. Listy 1989; 90: 597–603.

27. Li Marzi V, Filocamo MT, Dattolo E, et al. The treatment of fistulae and ureteral stenosis after kidney transplantation. Transplant. Proc. 2005; 37: 2516–2517.

28. Neri F, Tsivian M, Coccolini F, et al. Urological complications after kidney transplantation: Experience of more than 1000 transplantgations. Transplant. Proc. 2009; 41: 1224–1226.

29. Smith KM, Windsperger A, Alanee S, et al. Risk factors and treatmenst success for ureteral obstruction after pediatric renal transplantation. J. Urol, 2010; 183: 317–322.

30. Kaskarelis I, Koukoulaki M, Georgantas T, et al. Ureteral complicationsin renal transplant recipients succesfully treated with interventional radiology. Transplant. Proc. 2008; 40: 3170–3172.

31. Burgos FJ, Bueno G, Gonzales R, et al. Endoscopic implants to treat complex ureteral stenosis after kidney transplantation. Transplant. Proc. 2009; 41: 2427–2429.

32. Nahas WC, Antonopoulos IM, Piovesan AC, et al. Comparison of renal transplantation outcomes in children with and wihout bladder dysfunction. J. Urol. 2008; 179: 712–716.

33. Nimeh T, Ng CS, Goldfarb DA, Klein EA. Orthotopic neobladder and subsequent renal transplantation. Urology 2002; 60: 911.

34. Selli C, Boggi U, Travaglini F, et al. Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation: good preservation of the renal function.Transpl. Int. 2004; 17: 97–100.

35. Trivedi A, Patel S, Devra A, et al. Management of calculi in a donor kidney. Transplant. Proc. 2007; 39: 761–762.

36. Karacan I, Dervent A, Cunningham G, et al. Assessment of nocturnal penile tumescence as an objective method for evaluating sexual functioning in ESRD patients. Dialysis Transplant. 1978; 7: 872–876.

37. Procci WR, Goldstein DA, Adelstein J, Massry SG. Sexual dysfuction in the male patients with uremia: A reappraisal. Kidney Int. 1981; 19: 317–323.

38. Palmer BF. Sexual dysfunction in uremia. J. Am. Soc. Nephrol. 1999; 10: 1381–1388.

39. Lim VS, Fang VS. Gonadal dysfunction in uremic men: A study of the hypothalamo-pituitary-testicular axis before and after renal transplantation. Amer. J. Med. 1975; 58: 655–662.

40. Akbari F, Alavi M, Esteghamati A, et al. Effect of renal transplantation on sperm quality and sex hormone levels. BJU Int. 2010; 92: 281–283.

41. Breza J. Erektilné poruchy. Ich anatomické a funkčné základy, diagnostika a liečba. Martin, Osveta, 1994; 271.