Management of Urologic Complications of Renal Transplantation

Renal transplantation is now considered the treatment of choice for end-stage renal disease despite its medical and surgical complications. The main surgical complications of renal transplantation are urologic and related to the quality of the transplant ureter and the quality of the ureterovesical anastomosis. These complications are a major concern in most cases because they occur in a high-risk clinical setting in patients with a solitary functioning kidney. They generate considerable morbidity and excess cost but have little impact on long-term graft survival when they are managed rapidly. The incidence of these complications has decreased over time with a better knowledge of their mechanisms of onset and progress in surgical techniques. The complication rate currently appears to be stabilizing despite the increasingly frequent use of transplants derived from frailer and older extended criteria donors. Some complications may occur during the first postoperative month, corresponding to urinary fistulas and ureteric obstructions by extrinsic compression. Other complications may occur later, such as ureteric stenosis or vesicoureteric reflux. Patients with these complications must be managed in a specialized unit to ensure optimal preservation of graft function and graft survival. Patient summary: This article describes the urologic complications of renal transplantation. Early onset ureteric fistulas require rapid surgical management to avoid other later complication. The treatment of ureteric stenoses has benefited from progress in endourology, but many cases still require conventional surgical management. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.