Urological complications of renal transplantation: Reducing the risk

Urological complications can have a significant effect on the outcome of renal trans­plantation including the loss of the graft. The aims of this study were to determine the incidence of urological complications occurring after kidney transplantation at our unit, and how the risk of com­plications can be reduced. All 398 renal transplantations performed at Derriford Hospital, Plymouth between August 1997 and December 2006 were reviewed. Twenty nine (7.3%) urological com­plications were noted with a median time to diagnosis of 8.5 days (range 1-950 days) following transplantation; 81% occurring within two weeks. Fourteen (48.3%) of these patients had iden­tifiable risk factors; 10 patients required ureteric reimplantation, 6 had Boari flap reconstruction, and 3 underwent transurethral resection prostatectomy. One graft was lost to severe ureteric nec­rosis. Steps to reduce the risk of complications include avoiding damage to organs during retrieval, meticulous bench preparation including hydrodilating ureters to exclude ureteric injury and vigi­lance during the transplant procedure. Prompt and appropriate corrective surgery can diminish the effect of urological complications on graft survival.