The role of minimally invasive methods in management of urological complications and diseases after kidney transplantation in the follow-up period

Obstructive complications after kidney transplantation typically occur due to the ureter stricture and more rarely are caused by concrement occlusion and vesikoureteraler reflux. Pollakiuria and nocturia are also common in such patients. As more people over 60 are subjected to kidney transplantation more transplant recipients are susceptible to benign prostate hyperplasia, prostate cancer and female stress urinary incontinence. The increase in transplantation rate inevitably leads to the growth in the number of recipients with nonfunctioning transplant requiring resumption of hemodialysis. Direct endoureterotomy is the most effective method of endoscopic correction of urinary stricture with the efficiency rate of 79%. Although up to 6 month long ureteral stenting allows one to improve the result of the treatment, it increases the risk of infectious complications. Shock-wave lithotripsy, ureterolithotripsy or percutaneous lithotripsy are possible in the case of nephrolitiasis. Shock-wave lithotripsy is carried out when a concrement is smaller than 15 mm. Two or more sessions are usually necessary to dispose a stone, the absence of the ureter stent increases the risk of obstruction. Percutaneous nephrolithotomy is advisable in the case of bigger kidney stones. Endoscopic correction with any injection technique seems to be a plausible alternative to correction of refluxing posttransplant ureters, with the average efficiency rate of 50%. In the case of moderate reflux the results are better. Transurethral operations is advisable in patients with bladder outlet obstruction not earlier than 1-1.5 month after the transplantation. If the transplant is not functioning and the patient undergoes hemodialysis, embolization can be used instead of transplant nephrectomy provided the absence of acute pyelonephritis, rejection episode or transplant tumor. The efficiency rate of the interventional treatment stands at 84%.

почечный трансплантат, стриктура мочеточника, обструкция мочеточника, инфравезикальная обструкция, пузырно-мочеточниковый рефлюкс, нефролитиаз, дистанционная ударно-волновая литотрипсия, перкутанная нефролитолапаксия, трансплантатэктомия, эмболизация почечного трансплантата, transplant, ureteral stricture, ureteral obstruction, bladder outlet obstruction, urinary retention, vesicoureteral reflux, stone, calculi, shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, transplant nephrectomy, embolization of non-functioning renal allograft

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