Abstract
Interventional endourologic procedures were performed in 21 of 257 renal transplant recipients, representing a rate of urologic complications of 8.2%. Antegrade pyelography studies are the key to the diagnosis of ureteral obstruction or leakage. Retrograde manipulations failed in 57%, especially in the early postoperative period when the ureteroneocystostomy was found to be grossly edema to us. In cases of suspected obstruction and hydronephrosis, antegrade procedures are more suitable, especially when temporary urinary diversion is also needed. In cases of ureteral compression by pararenal fluid collections, puncture and temporary percutaneous drainage usually solve the problem. Leaks at the site of the ureteroneocystostomy are successfully treated by endourologic procedures, whereas surgical intervention is indicated in cases of ureteral necrosis; however, primary differentiation between leakage and ureteral necrosis is not possible. A success rate of 60% in cases of leakage justifies a primary endourologic approach. Five patients (24%) required subsequent surgery, but temporary urinary diversion prior to the operation was nonetheless helpful. Sixteen patients (76%) were cured by endourologic procedures alone. Only one procedure-related complication (4.7%) was observed. Invasive percutaneous and endoscopic uroradiologic techniques for the diagnosis and treatment of urologic complications in the aftermath of renal transplantation may be considered safe.
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