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Advances in Urology
Volume 2013 (2013), Article ID 246520, 6 pages
http://dx.doi.org/10.1155/2013/246520
Review Article

The Current Role of Endourologic Management of Renal Transplantation Complications

1Department of Urology, Oregon Health & Science University, 3033 SW Bond Ave, CH10U, Portland, OR 97239, USA
2Department of Urology, Oregon Health & Science University/Portland VA Medical Center, 3033 SW Bond Ave, CH10U, Portland, OR 97239, USA
3Departments of Urology and Surgery, Oregon Health & Science University, 3033 SW Bond Ave, CH10U, Portland, OR 97239, USA

Received 27 May 2013; Revised 20 July 2013; Accepted 22 July 2013

Academic Editor: Hiep T. Nguyen

Copyright © 2013 Brian D. Duty et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.