Management of urologic complications of the transplanted kidney. Personal experience

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Abstract

Introduction. Global statistics points out an annual rise in the number of patients with end-stage kidney disease requiring renal replacement therapy, the best treatment method for which is kidney transplantation (KT). The last decade has been characterized by the development of the transplant service in the Russian Federation, as evidenced by the growing number of patients who underwent KT. One of the most frequent complications after a kidney transplant are urological complications (UС). Despite the growth of the quality of operations, UC lead to prolonged hospitalization and serious adverse health outcomes for the patient and could be the cause of both graft loss and death of the patient.

Objective. To assess the range and nature of urological complications after allotransplantation of the cadaver kidney and methods of their correction.

Materials and methods. The analysis of the outcomes of 209 kidney transplantations, performed in the Krasnoyarsk transplant centers, from a deceased donor for the period from 2014 to 2021 allowed to distinguish a group of 22 patients with urological complications, this group also included 5 patients who underwent KT outside the Krasnoyarsk Territory.

Results. The most frequently encountered UC are ureteral strictures of the transplanted kidney and vesico-ureteral reflux (VUR), stones and cysts of the transplanted kidney are recorded in a smaller number. Methods for correcting UC are based on the main principles of treatment in urology. 5 patients with a diagnosed uretero-cysto-anastomosis stricture less than 10 mm in length underwent antegrade laser ureterotomy, with a length of more than 10 mm, a reconstructive intervention with the formation of either a repeated uretero-cysto-anastomosis or neocystostomy was performed. The development of total ureteral obliteration in 2 cases required an ipsilateral laparoscopic nephrectomy applying an anastomosis between the proper ureter and the pelvis of the transplanted kidney. The formation of stones of the transplanted kidney was observed in 2 patients who underwent percutaneous nephrolitholapaxy, for ureteral stones observed in 3 patients flexible ureteroscopy with contact laser lithotripsy was performed, retrograde in 2 cases, and antegrade through a previously formed nephrostomy fistula in one case. VUR in combination with recurrent attacks of pyelonephritis was observed in 6 patients - 4 patients underwent endovesical plasty of the ureteral stoma using volume- forming substances. 2 patients, as well as in the absence of the effect of endovesical correction, underwent reconstructive surgery using their own ureter and the formation of ureteropyeloanastomosis with the pelvis of the transplanted kidney. Renal transplant cysts were recorded in 6 patients, 2 patients underwent percutaneous drainage of the cyst due to the clinical relevance of the cysts. Recurrent course of the cyst was noted in 1 patient, which subsequently required laparoscopic excision of the cyst. In all cases, a positive clinical effect was achieved.

Conclusion. The number of patients with urological pathology of the transplanted kidney increases annually due to the increase in the total number of KT. Most often, pathological states of a transplanted kidney in the long-term period are of a urological nature, and the infectious and inflammatory complications associated with them are the main reason for transplant removal. Correction of UC of a transplanted kidney is carried out according to the basic urological principles.

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About the authors

М. А. Firsov

Regional Clinical Hospital; Voyno-Yasenetsky Krasnoyarsk State Medical University

Author for correspondence.
Email: firsma@mail.ru
ORCID iD: 0000-0002-0887-0081

Cand. Sci. (Med.),

Russian Federation, Krasnoyarsk; Krasnoyarsk

E. A. Bezrukov

Voyno-Yasenetsky Krasnoyarsk State Medical University; Sechenov First Moscow State Medical University (Sechenov University)

Email: eabezrukov@rambler.ru
ORCID iD: 0000-0002-2746-5962

D. Sci. (Med.)

Russian Federation, Krasnoyarsk; Moscow

D. N. Spirin

Voyno-Yasenetsky Krasnoyarsk State Medical University

Email: manakodidim@mail.ru

Student

Russian Federation, Krasnoyarsk

V. S. Arutiunian

Loginov Moscow Clinical Scientific Center

Email: ar_vagan@mail.ru
ORCID iD: 0000-0003-4197-2933

Medical Resident

Russian Federation, Moscow

P. A. Simonov

Regional Clinical Hospital

Email: wildsnejok@mail.ru
ORCID iD: 0000-0002-9114-3052

urologist

Russian Federation, Krasnoyarsk

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2. 1-stone in the projection of the pyeloureteral segment. 2-flexible ureterorenoscope is passed through the ureteral sheath to perform contact ureterolithotripsy. Fig. 1. Data from an X-ray examination of a patient with a kidney transplanted into the right iliac region: A. MSCT. B. Radiographic image during retrograde flexible ureterolithotripsy

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3. 1-transplanted kidney. 2-cyst of the sinus of the transplanted kidney. Rice. 2. MSCT of a patient with a kidney transplanted into the right iliac region A – in the horizontal plane (axial image), B – in the frontal plane (coronal image).

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4. 1-calyceal-pelvic system of a kidney transplanted into the right iliac region. 2-narrowed area of the transplanted ureter (stricture). 3-bladder. Rice. 3. Antegrade flexible ureteropyeloscopy with laser ureterotomy of a kidney transplanted into the right iliac region

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5. Fig. 4. Mixture cystogram. Vesicoureteral reflux into the transplanted kidney is noted

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