Urinary stasis in transplanted kidney - twenty years of experience of one transplant center

Abstract

Introduction. Urinary stasis in transplanted kidney occurs due to ureteral obstruction caused by intrinsic or extrinsic etiological factors. The aim of this study was to determine the prevalence, time of occurrence and etiopathogenetic factors of urinary stasis and their distribution according to the type of kidney donor. And to analyze the success of different types of surgical and conservative treatment. Methods. The retrospective-prospective randomized study included 580 patients transplanted in Transplant Center, Clinic of Urology, Clinical Center of Serbia for a period of 20 years. After diagnosing urinary stasis, minimally invasive or open surgical interventions were performed, while for one group of patients the definitive treatment was non-surgical with observation and active monitoring. The main control parameters during non-surgical treatment were diameter of pyelon, serum creatinine values and urine culture findings. Results. Urinary stasis was found in 15% of transplanted patients. The largest number of transplanted patients had early urinary stasis, within 3 months of transplantation (68%). The most common etiological factors of urinary stasis were intrinsic factors (66%), which were significantly more frequent in transplant patients from a living donor. Non-surgical treatment with observation and active monitoring was successfully performed in 22% of patients. Conclusion. The largest number of transplanted patients with urinary stasis has been successfully treated surgically, most often with open surgery. Surgical correction is advised in cases of pronounced dilatation of the canalicular system with a tendency to increase, in progressive decrease in renal function and recurrent complicated urinary infections refractory to antibiotic therapy.