Ján Breza ml., Zuzana Žilinská, Martin Chrastina, Branislav Trebatický, Peter Bujdák, Zuzana Kizeková, Ján Breza st.
Objective: Complications of urological nature related to the reconstruction of the urinary tract belong to the most severe issues after kidney transplantation. The ureter of the transplanted kidney is almost certainly the most vulnerable part of the urinary tract on its reconstruction. The objective of the work is to present our experience with the occurrence, diagnostics and treatment of urological complication arising from various pathological states affecting the ureter of the transplanted kidney. Materials and methods: In the period from 2006 to 2010, 272 kidneys were transplanted: 163 to males aged between 19 and 63, 106 to females between 20 and 66 years, and 3 to children from 11 to 15 of age. 242 kidneys were removed from cadaveric donors, 30 patients received kidneys from living donors. In most cases, reconstruction of the urinary tract was performed by transvesical anti-reflux re-implantation of the ureter. In the last 3 years the “double J” ureteral stents with thickness 7 Char were commonly used. Results: Complications affecting the ureter of the transplanted kidney were observed in 14 patients: stricture of the ureter in 7 patients, kinking of the ureter in 3 patients, injured ureter in 3 patients, and necrosis of the ureter in one female patient. In all cases of stricture and kinking, the broken drainage of the urine from the transplanted kidney resulted in asymptomatic ureterohydronephrosis that was found on regular check-up. In 3 patients, urinary fistulae developed after iatrogenic injury of the ureter, and in one female patient because of necrosis of the terminal section of the ureter. In all 14 patients, punction nephrostomy was conducted as a primary diagnostic and at the same time therapeutic intervention. Subsequently, all complications were resolved by open revisions. Conclusion: The important measures affecting the occurrence of urological complications after kidney transplantation include mainly prevention of their inception. It consists in a perfect and cautious technique of kidney removal maintaining the anatomic and functional integrity of all anatomical structures of the kidney, including the ureter. The use of ureteral stents and treatment of concomitant infections, that are the result rather than the cause of urological complications, have been proved to be important aspects in the prevention of complications from the side of the ureter of the transplanted kidney.