title: The development and current status of minimally invasive surgery to manage urological complications after renal transplantation.
abstract: BACKGROUND
  In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques.
  
  
  METHODS
  A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed.
  
  
  RESULTS
  The incidence of urological complications postrenal transplantation was reported to be 2-13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50-70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients.
  
  
  CONCLUSIONS
  Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Ravindra B
authors.initials: RB
authors.lastname: Sabnis
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Abhishek G
authors.initials: AG
authors.lastname: Singh
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Arvind P
authors.initials: AP
authors.lastname: Ganpule
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Chhabra
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Gopal R
authors.initials: GR
authors.lastname: Tak
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Jaimin H
authors.initials: JH
authors.lastname: Shah
keywords: Minimally invasive; renal transplantation; urological complications