Impact of Open Vs Laparoscopic Kidney Harvesting and Routine Use of Double J Stent on Longterm Outcome of Ureteral Complications in Renal Transplants

Abstract

Background: Ureter related complications are an important cause of morbidity in renal transplant patients. Herein we present our experience and management of such complications. The impact of laproscopic live donor nephrectomy on ureter related complications was also analyzed.

Methods: Our practice of vesico-ureteral anastomosis has evolved as phase I from 1989 to 1993 when stent was put only when felt necessary, phase II from January 1994 to April 1995, when stent placement was randomized and phase III from May 1995 to December 2010, where all anastomosis were stented. Kidney was removed by open method till 1998 and laparoscopic nephrectomy (left side) was started from 2002 onwards.

Results: Incidence of ureteral leak without DJ stent was 6.1% and 0.4% with stent. Overall incidence of ureteral stenosis was 0.8%. Incidence of stenosis in stented and non-stented group was 0.8% and 2.3% respectively. Treatment offered for ureteral stenosis was percutaneous nephrostomy and antegrade stent. Ureteral leak was present in 0.3% and 1.5% in open and laproscopic method respectively and ureteral stenosis in 0.9% and 0.75% respectively.

Conclusion: Two major ureter related complications were leak and stenosis and three-fourth of them resolved by minimal invasion. Major surgical revision was needed in around one-fourth of cases. Stent use helps in reducing incidence of ureteral leak, but doesnt seem to have any impact on ureteral stenosis. Laparoscopic technique doesnt seem to have any adverse effect on ureter-related complications.




doi:10.4021/wjnu25w