Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Management of Urological Complications After Renal Transplantation: Our Experience and Technical Alternatives: Retrospective Clinical Research
Böbrek Nakli Sonrası Ürolojik Komplikasyonların Yönetimi: Deneyimlerimiz ve Teknik Alternatifler: Retrospektif Klinik Araştırma
Mesut DEMİRa, İbrahim Halil BALOĞLUb, Şeyma DEMİRCİa
aDepartment of Pediatric Surgery, University of Health Sciences Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
bDepartment of Urology, University of Health Sciences Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
J Reconstr Urol. 2022;12(2):84-9
doi: 10.5336/urology.2022-91459
Article Language: EN
Full Text
ABSTRACT
 Objective: Renal transplantation is the primary treatment method for end-stage kidney disease. Many reasons such as surgical reasons and infection may cause urological complications after transplantation. Management of renal transplantation urinary complications requires respectable surgical experience. In this study, we aimed to present the management of patients who require surgical reconstruction after renal transplantation at our center. Material and Methods: The data of 16 patients who underwent reconstructive surgery after transplantation were reviewed retrospectively. The patients' demographic data were evaluated. Which reconstructive method was applied to the patients, timing of surgical correction after transplantation, pre and post-surgical glomerular filtration rate (GFR) were evaluated. Result: Them mean age of the patients was 35.6 years. The mean time from transplantation to reconstructive surgery was 312 days. The average postoperative hospitalization time was 11.2 days. The earliest complication was total ureteral necrosis seen on the 21st postoperative day and the latest complication was vesicoureteral reflux (VUR) in our series. In patients who developed VUR, VUR was seen more than 6 months after the operation. Nephrostomy was placed in 75% of patients. Ureteroneocystostomy was applied to 3 patients (18.7%), one was applied with Boari flap, and two were applied with modified Lich-Gregoir technique. Pre-operative GFR inter-quantile range (IQR): 35.6-70.3, postoperative first-month GFR IQR: 47.4-69.5, third postoperative months GFR IQR: 50-74.5 were detected. A significant difference was observed between preoperative GFR and postoperative third month GFR (p=0.007). Conclusion: Reconstructive surgery following kidney transplantation is a challenging but effective method. Even if it is performed in different centers, complications after transplantation are likely to occur.

Keywords: Renal transplantation; complications; reoperation
ÖZET
 Amaç: Böbrek transplantasyonu, son dönem böbrek yetersizliğinde esas tedavi yöntemidir. Cerrahi teknik, enfeksiyon gibi birçok sebep transplantasyon sonrası ürolojik komplikasyon gelişmesine sebep olabilir. Transplantasyon sonrası ürolojik komplikasyonların yönetimi iyi bir cerrahi tecrübe gerektirir. Bu çalışmada, merkezimizde böbrek transplantasyonu sonrası cerrahi rekonstrüksiyonu yapılan hastaların yönetimini sunmayı amaçladık. Gereç ve Yöntemler: Transplantasyon sonrası rekonstrüktif cerrahi uygulanan 16 hastanın verileri geriye dönük olarak incelendi. Hastaların demografik verileri değerlendirildi. Hastalara hangi rekonstrüktif yöntemin uygulandığı, transplantasyon sonrası cerrahi düzeltmenin zamanlaması ve cerrahi öncesi ve sonrası glomerüler filtrasyon hızı [glomerular filtration rate (GFR)] değerlendirildi. Bulgular: Hastaların ortalama yaşı 35,6'dır. Transplantasyondan rekonstrüktif cerrahiye kadar geçen ortalama süre 312 gündü. Operasyon sonrası ortalama yatış süresi 11,2 gün idi. Bizim serimizde en erken komplikasyon postoperatif 21. günde görülen total üreteral nekroz, en geç komplikasyon vezikoüreteral reflü (VUR) idi. VUR gelişen hastalarda VUR operasyondan 6 aydan fazla süre geçtikten sonra görülmüştür. Hastaların %75'ine nefrostomi takıldı. Bir hastaya Boari flap yöntemi, 2 hastaya modifiye Lich-Gregoir tekniği ile toplamda 3 (%18,7) hastaya üreteroneosistostomi yapıldı. Ameliyat öncesi GFR çeyrekler açıklığı [inter-quantile range (IQR)]: 35,6- 70,3 ameliyat sonrası 1. ay GFR IQR: 47,4-69,5, ameliyat sonrası 3. ay GFR IQR: 50-74,5 olarak belirlendi. Ameliyat öncesi GFR ile ameliyat sonrası 3. ay GFR arasında anlamlı bir fark gözlendi (p=0,007). Sonuç: Böbrek nakli sonrası rekonstrüktif cerrahi zorlu ama etkili bir yöntemdir. Farklı merkezlerde yapılsa bile nakil sonrası komplikasyonların oluşması muhtemeldir.

Anahtar Kelimeler: Böbrek transplantasyonu; komplikasyonlar; reoperasyon
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