Complications into Urinary Tract Following Renal Transplantation: Influence of Bladder Anastomosis Technique and Urinary Catheters (Double J stent and urethral catheterization)
Jose Medina-Polo1, Manuel M Pamplona Casamayor1, Federico F De La Rosa Kehrmann1, Alfredo A Rodríguez Antolín1, José Manuel JM Duarte Ojeda1, Ángel A Tejido Sánchez1, Felipe F Villacampa Aubá1, Juan J Passas Martínez1, Amado A Andrés Belmonte2.
1Urology, Hospital Universitario 12 de Octubre, Madrid, Spain; 2Nephrology-Transplant Coordination, Hospital Universitario 12 de Octubre, Madrid, Spain
Introduction & Objectives: Complications related to urinary tract anastomosis are reported in up to 10% of cases after renal transplantation. The type of bladder anastomosis and urinary catheters as double J stents may influence the development of urological complications and urinary tract infections.
Our purpose was to analyze whether the type of urinary anastomosis in kidney transplantation influences the incidence of complications in the urinary tract.
Material & Methods: A retrospective study was carried out assessing urinary tract complications after kidney transplantation. The study included 1503 kidney transplantations performed at our center between 2006 and 2015. Urinary tract complications included urinary fistula, obstructive uropathy, and urinary tract infections. The analysis was stratified into two groups according to the type of ureterovesical anastomosis and double J stent placement.
Results: Ureterovesical anastomosis was conducted using an intravesical technique in 1414 patients (94,0%), extravesical in 75 (5.0%) and ureteral-ureteral anastomosis was required in 14 cases. Double J stent was used in all cases with extravesical technique and 47.6% (673/1414) of cases with intravesical technique.
The incidence of urinary fistula was 2.8% in the extravesical anastomosis group and 4.8% if intravesical anastomosis, independently whether double J stent was used. Ureteral dilatation was diagnosed in 4.6% and 2.8% after intra and extravesical techniques, respectively. Hematuria requiring surgery or urinary catheter manipulation was shown in 4.5% with intravesical anastomosis and double J stent placement and 4.8% in those without double J stent. No cases of hematuria requiring treatment were reported among those with extravesical anastomosis.
The incidence of urinary infections in the early postoperative period was 12% if extravesical anastomosis. The incidence of UTIs in patients with intravesical anastomosis was 15% and 11.9% in those with and without double J stent, respectively. The mean time with bladder catheter was 12.2 days in patients with UTI in comparison with 11.4 days in those without urinary infections (p=0.005). Statistically differences were not found regarding the mean time with double J stent in patients with or without UTI, 17.6 and 16.8 days, respectively (p=0.495).
Conclusions: According to our data, the type of bladder anastomosis using intra or extravesical anastomosis is statistically not associated with the incidence of ureteral fistula or obstructive uropathy. However, hematuria which requires treatment is more frequent in recipients with intravesical anastomosis. Moreover, longer times with urinary catheters are related with a higher incidence of urinary tract infections. Therefore, urinary catheter must be removed as soon as possible in order to prevent the development of infections.
