Duty Brian D, Barry John M
Department of Urology, Oregon Health & Science University, Portland, OR, USA.
Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, OR, USA.
Asian J Urol. 2015 Oct;2(4):202-207. doi: 10.1016/j.ajur.2015.08.002. Epub 2015 Aug 24.
When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic), urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter). Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.
与维持性透析相比，肾移植能为终末期肾病患者带来更好的长期生存率和更高的生活质量。肾移植后约9%的患者会发生严重的泌尿系统并发症。输尿管并发症最为常见，包括梗阻（内在性和外在性）、尿漏和膀胱输尿管反流。输尿管膀胱吻合口狭窄由技术失误或输尿管缺血引起。对于短段、轻度狭窄，可考虑球囊扩张或输尿管内切开术，但开放重建成功率更高。尿漏通常发生在术后早期。近60%的患者通过盆腔引流和尿液减压（肾造瘘管、输尿管支架和留置膀胱导管）可成功处理。近端、大量漏尿或尽管进行了尿液转流仍持续漏尿的情况，需要开放修复。移植后膀胱输尿管反流很常见。尽管进行了抗菌预防仍反复发生肾盂肾炎的患者需要手术治疗。病情较轻的受者可考虑注射Deflux。IV级和V级反流最好通过开放重建处理。
