Oosterhof G O, Hoitsma A J, Witjes J A, Debruyne F M
Department of Urology, Radboud University Hospital, Nijmegen, The Netherlands.
Urol Int. 1992;49(2):99-103. doi: 10.1159/000282402.
Between January 1973 and January 1990 we carried out 1,038 kidney transplantations using a transvesical end-to-side implantation of the ureter in the bladder without an antireflux mechanism. Moreover, 30 transplantations were done in 26 patients with a urinary diversion. We examined the urological complications in these 1,068 consecutive transplants. Urinary leakage and obstruction were the two main urological posttransplant complications. Severe leakage occurred in 21 patients (2.0%), and was treated by open surgery; 2 patients had a urinary diversion. The treatment of choice is a pyeloureterostomy (anastomosis between the transplant renal pelvis and the native ureter). There were 35 patients (3.3%) with severe ureteral obstruction of whom 5 had a urinary diversion. In 30 patients open surgical treatment of the obstruction was necessary and in 7 patients a percutaneous endourologic treatment was done (dilatation of a confined ureteral stricture in 6 patients and percutaneous stone treatment in 1). The postoperative mortality in the patients treated for leakage or obstruction was low: 4 patients (7%) died, 3 of septicemia due to leakage and 1 of pulmonary embolism after repair of the obstruction. The results of surgical treatment were good. The graft survival after 2 years in the group of urologically complicated transplants was 68% for the patients with leakage and 80% for those with obstruction. The 2-year graft survival in the patients without complications was 67% and 71% for the patients with a urinary diversion. We conclude from these results that urological complications after renal transplantation can be treated successfully by surgical (or percutaneous) correction.
1973年1月至1990年1月期间，我们采用输尿管经膀胱端侧植入膀胱且无抗反流机制的方法进行了1038例肾移植手术。此外，对26例尿流改道患者进行了30例移植手术。我们检查了这1068例连续移植手术中的泌尿系统并发症。尿漏和梗阻是肾移植术后两个主要的泌尿系统并发症。21例患者（2.0%）发生严重尿漏，通过开放手术治疗；2例患者进行了尿流改道。首选的治疗方法是肾盂输尿管吻合术（移植肾肾盂与自体输尿管之间的吻合）。35例患者（3.3%）发生严重输尿管梗阻，其中5例进行了尿流改道。30例患者需要对梗阻进行开放手术治疗，7例患者进行了经皮腔内泌尿外科治疗（6例患者为局限性输尿管狭窄扩张，1例患者为经皮结石治疗）。因尿漏或梗阻接受治疗的患者术后死亡率较低：4例患者（7%）死亡，3例死于尿漏引起的败血症，1例死于梗阻修复后的肺栓塞。手术治疗效果良好。泌尿系统并发症移植组中，尿漏患者2年后的移植肾存活率为68%，梗阻患者为80%。无并发症患者的2年移植肾存活率为67%，尿流改道患者为71%。我们从这些结果得出结论，肾移植术后的泌尿系统并发症可以通过手术（或经皮）矫正成功治疗。
