Urological Complications in Renal Transplantation
Summary
Urological complications remain a significant challenge following renal transplantation, affecting up to 10 per cent of recipients and contributing to morbidity, graft dysfunction and increased healthcare costs. The most frequent issues include ureteric strictures, urinary leaks, vesicoureteral reflux and obstructive uropathy. Strictures commonly arise at the ureteroneocystostomy site and may present weeks to months post-transplant as hydronephrosis, rising serum creatinine or recurrent urinary tract infections. Urinary leaks typically occur in the early postoperative period and demand prompt radiological or surgical intervention. Vesicoureteral reflux in the allograft can range from asymptomatic low-grade reflux to high-grade reflux associated with recurring infections and progressive graft injury. Risk factors encompass donor characteristics (such as multiple renal arteries or prolonged ischaemia), recipient factors (including bladder dysfunction and gender) and surgical technique. Advances in perioperative assessment, refinements in ureteral implantation and the judicious use of stents have reduced complication rates, while minimally invasive endourological approaches have emerged as effective first-line treatments for selected patients. Early detection through imaging modalities and tailored management strategies are essential to safeguard long-term graft survival.
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Urological Complications in Renal Transplantation publication trend
The graph below shows the total number of articles in urological complications in renal transplantation across all publications each year (not limited to Nature Index journals).
Technical terms
Ureteroneocystostomy: The surgical creation of an anastomosis between the donor ureter and the recipient bladder.
Ureteric stricture: Narrowing of the ureteric lumen that impedes urine flow, often at the site of implantation.
Urinary leak: Extravasation of urine from the ureteric anastomosis into the surrounding tissues.
Vesicoureteral reflux: Retrograde flow of urine from the bladder into the transplant ureter and pelvicalyceal system.
Percutaneous nephrostomy: Image-guided placement of a catheter into the renal pelvis to decompress obstruction or leak.
References
- The Ureter in the Kidney Transplant Setting: Ureteroneocystostomy Surgical Options, Double-J Stent Considerations and Management of Related Complications. Current Urology Reports (2020).
- Independent Risk Factors for Urological Complications after Deceased Donor Kidney Transplantation. PLOS ONE (2014).
- Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients. PLOS ONE (2021).
- Minimal-invasive management of urological complications after kidney transplantation. International Urology and Nephrology (2021).
- Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration. World Journal of Urology (2023).
- Allograft Vesicoureteral Reflux after Kidney Transplantation. Medicina (2022).
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