Cárcamo Valor P I, Mora M, Navarro J, García-Matres M J, Fiter L, Mosteiro J A, Cozar J M, Gastón de Iriarte E, Martínez-Piñeiro J A
Servico de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid.
Actas Urol Esp. 1990 Mar-Apr;14(2):104-11.
We introduce our case material on urological complications occurred in 107 renal transplants, 102 of which were from corpse donors and 5 form live donors. The techniques used for the reconstruction of the urinary tract were: extravesical ureterocystoneostomy (91 = 85%), pyelo-pyelic anastomosis (15 = 14%) and uretero-ureteral anastomosis (1 = 0.9%). Sixteen cases presented urinary fistula (15%), emphasizing the high percentage of extravasations occurred in the pyelo-pyelic anastomosis (5/15). The resolution of the problem with graft preservation was achieved in 11 cases (68.75%). We encountered 6 ureteral obstructions that resolved favourably in 100% if the cases. Other important complications were: appearance of lymphocele in 8 cases, detection of post-grafting ureteral stenosis in 5 patients, finding asymptomatic vesicoureteral reflux in 16 grafts, and presence of urinary lithiasis in 2 cases. Similarly, we analyzed our series of 16 vascular complications, emphasizing that 15 out of 107 grafts had arterial or venous vascular abnormalities (14.1%), that forced to perform bench surgery in two occasions. Our statistical analysis showed that arterial thrombosis was more frequent than stenosis (8.49% versus 4.71%), and in nearly 80% of the cases (7/9) it happened in grafts concerning more than one arterial vessel, including in this series thrombosis of any of the ramus. The largest loss of grafting were due to this complication, since in 5 out of 9 cases of arterial thrombosis (55.5%) a transplantectomy had to be performed. With regard to venous complications thrombosis is a relatively rare complication, representing in our series less than 1%, usually associated to uncontrollable vascular acute rejection.
