title: Ureteral Complications in Kidney Transplantation: Analysis and Management of 853 Consecutive Laparoscopic Living-Donor Nephrectomies in a Single Center.
abstract: BACKGROUND
  We report the incidence and nature of ureteral and surgical complications in our series of 853 consecutive living-donor renal transplants after laparoscopic living-donor nephrectomy. The aim of this study was to analyze the therapeutic approaches to ureteral complications in kidney transplantations and their relationship with recipient outcome.
  
  
  METHODS
  The medical records of patients who underwent kidney transplantation from 2000 to 2014 were reviewed retrospectively. After the donor nephrectomies were performed with the use of laparoscopic, hand-assisted laparoscopic, and vesico-ureteral anastomosis, the recipient's ureteral complications were classified according to the mechanism and site of urinary tract involvement: anastomosis stricture, anastomosis leakage, vesico-ureteral reflux, and urolithiasis.
  
  
  RESULTS
  Among the 853 cases of kidney transplantation, ureteral complications occurred in 66 patients (7.73%). The most common complication was urinary tract infection caused by vesico-ureteral reflux (n = 24, 2.81%), which was managed with by means of sub-ureteral polydimethylsiloxane injection. The second most common complication was the anastomosis site stricture (n = 23, 2.69%), which was treated by means of ureteral re-implantation or percutaneous nephrostomy. Anastomosis site leakage occurred in 11 patients (1.28%) and was managed by percutaneous nephrostomy with double-J stenting and drainage or ureteral re-implantation. Urolithiasis occurred in 8 patients (0.93%).
  
  
  CONCLUSIONS
  There was an 8% rate of recipient ureteral complications at our institution. Of the 66 patients, 46 (5.4%) required surgical repair. The remaining 20 patients with ureteral complications were treated with conservative care or minimally invasive procedures. The keys to successful management of these problems are early diagnosis and prompt reconstruction whenever possible. Most ureteral complications are easily managed with a successful outcome with early intervention.
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: Y S
authors: YS
authors: Choi
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: K S
authors: KS
authors: Kim
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: S W
authors: SW
authors: Choi
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: W J
authors: WJ
authors: Bae
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: S H
authors: SH
authors: Hong
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: J Y
authors: JY
authors: Lee
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: J C
authors: JC
authors: Kim
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: S W
authors: SW
authors: Kim
authors: Department of Nephrology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: B H
authors: BH
authors: Chung
authors: Department of Nephrology, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: C W
authors: CW
authors: Yang
authors: Department of Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: J I
authors: JI
authors: Kim
authors: Department of Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea.
authors: I S
authors: IS
authors: Moon
authors: Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea. Electronic address: a0969@catholic.ac.kr.
authors: H J
authors: HJ
authors: Cho
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D014570:Urologic Diseases / Q000453:epidemiology* / Q000209:etiology