Urological problems in kidney transplant recipients are not limited only to posttransplantation urological complications. These problems are a cause of significant patient mortality and morbidity that have wide-ranging effects on graft survival throughout the entire life of the graft. Ultimately, the transplant comprises a major portion of the urinary system; therefore, the transplant team should be prepared for foreseeable and unforeseeable urological problems in the short and long terms. These mainly include postoperative urological complications (urine leakage, ureteral stenosis, and vesicoureteral reflux), bladder outlet obstruction, and graft urolithiasis. In recent years, significant advances have been made in the management of urological complications, especially due to advances in endourologic interventions. The aim of this review is to summarize the management of urological problems after kidney transplantation in the context of the current literature.

1.
Özkaptan
O
,
Sevinc
C
,
Balaban
M
,
Karadeniz
T
.
Minimally invasive approach for the management of urological complications after renal transplantation: single center experience
.
Minerva Urol Nefrol
.
2018
;
70
(
4
):
422
8
. .
2.
Buttigieg
J
,
Agius-Anastasi
A
,
Sharma
A
,
Halawa
A
.
Early urological complications after kidney transplantation: an overview
.
World J Transplant
.
2018
;
8
(
5
):
142
9
. .
3.
Krajewski
W
,
Dembowski
J
,
Kołodziej
A
,
Małkiewicz
B
,
Tupikowski
K
,
Matuszewski
M
, et al.
Urological complications after renal transplantation: a single centre experience
.
Cent European J Urol
.
2016
;
69
(
3
):
306
11
. .
4.
Bruintjes
MHD
,
d’Ancona
FCH
,
Zhu
X
,
Hoitsma
AJ
,
Warlé
MC
.
An update on early urological complications in kidney transplantation: a National Cohort Study
.
Ann Transplant
.
2019
;
24
:
617
24
. .
5.
Bruintjes
MHD
,
d’Ancona
FCH
,
Zhu
X
,
Hoitsma
AJ
,
Warlé
MC
.
An update on early urological complications in kidney transplantation: a National Cohort Study
.
Ann Transplant
.
2019
;
24
:
617
24
. .
6.
Gratzke
C
,
Bachmann
A
,
Descazeaud
A
,
Drake
MJ
,
Madersbacher
S
,
Mamoulakis
C
, et al.
EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction
.
Eur Urol
.
2015
;
67
(
6
):
1099
109
. .
7.
Mangus
RS
,
Haag
BW
.
Stented versus nonstented extravesical ureteroneocystostomy in renal transplantation: a metaanalysis
.
Am J Transplant
.
2004
;
4
(
11
):
1889
96
. .
8.
Sarier
M
,
Seyman
D
,
Tekin
S
,
Duman
I
,
Uygun
B
,
Demir
M
, et al.
Comparision of ureteral stent colonization between deceased and live donor renal transplant recipients
.
Transplant Proc
.
2017
;
49
(
9
):
2082
5
. .
9.
Fockens
MM
,
Alberts
VP
,
Bemelman
FJ
,
Laguna Pes
MP
,
Idu
MM
.
Internal or external stenting of the ureterovesical anastomosis in renal transplantation
.
Urol Int
.
2016
;
96
(
2
):
152
6
. .
10.
Yuksel
Y
,
Tekin
S
,
Yuksel
D
,
Duman
I
,
Sarier
M
,
Yucetin
L
, et al.
Optimal timing for removal of the double-J stent after kidney tansplantation
.
Transplant Proc
.
2017
;
49
(
3
):
523
7
. .
11.
Sarier
M
,
Demir
M
,
Duman
I
,
Yuksel
Y
,
Demirbas
A
.
Evaluation of ureteral stent colonization in live-donor renal transplant recipients
.
Transplant Proc
.
2017
;
49
(
3
):
415
. .
12.
Visser
IJ
,
van der Staaij
JPT
,
Muthusamy
A
,
Willicombe
M
,
Lafranca
JA
,
Dor
FJMF
.
Timing of ureteric stent removal and occurrence of urological complications after kidney transplantation: a systematic review and meta-analysis
.
J Clin Med
.
2019
;
8
(
5
):
689
. .
13.
Mano
R
,
Golan
S
,
Holland
R
,
Livne
PM
,
Lifshitz
DA
.
Retrograde endoureterotomy for persistent ureterovesical anastomotic strictures in renal transplant kidneys after failed antegrade balloon dilation
.
Urology
.
2012
;
80
(
2
):
255
9
. .
14.
Gil-Sousa
D
,
Oliveira-Reis
D
,
Teves
F
,
Príncipe
P
,
Castro-Henriques
A
,
Soares
J
, et al.
Ureteral stenosis after renal transplantation: a single-center 10-year experience
.
Transplant Proc
.
2017
;
49
(
4
):
777
82
. .
15.
Lempinen
M
,
Stenman
J
,
Kyllönen
L
,
Salmela
K
.
Surgical complications following 1,670 consecutive adult renal transplantations: a Single Center Study
.
Scand J Surg
.
2015
;
104
(
4
):
254
9
. .
16.
Pichler
R
,
Buttazzoni
A
,
Rehder
P
,
Bartsch
G
,
Steiner
H
,
Oswald
J
.
Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico-ureteric reflux after renal transplantation
.
BJU Int
.
2011
;
107
(
12
):
1967
72
. .
17.
Hotta
K
,
Miura
M
,
Wada
Y
,
Fukuzawa
N
,
Iwami
D
,
Sasaki
H
, et al.
Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation
.
Int J Urol
.
2017
;
24
(
4
):
314
9
. .
18.
Salamanca-Bustos
JJ
,
Gomez-Gomez
E
,
Campos-Hernández
JP
,
Carrasco-Valiente
J
,
Ruiz-García
J
,
Márquez-López
FJ
, et al.
Initial experience in the use of novel auto-expandable metal ureteral stent in the treatment of ureter stenosis in kidney transplanted patients
.
Transplant Proc
.
2018
;
50
(
2
):
587
90
. .
19.
Kwong
J
,
Schiefer
D
,
Aboalsamh
G
,
Archambault
J
,
Luke
PP
,
Sener
A
.
Optimal management of distal ureteric strictures following renal transplantation: a systematic review
.
Transpl Int
.
2016
;
29
(
5
):
579
88
. .
20.
Xu
G
,
Li
X
,
He
Y
,
Zhao
H
,
Yang
W
,
Xie
Q
.
Use of self-expanding metallic ureteral stents in the secondary treatment of ureteral stenosis following kidney transplantation
.
J Endourol
.
2015
;
29
(
10
):
1199
203
. .
21.
Nie
ZL
,
Zhang
KQ
,
Li
QS
,
Jin
FS
,
Zhu
FQ
,
Huo
WQ
.
Treatment of urinary fistula after kidney transplantation
.
Transplant Proc
.
2009
;
41
(
5
):
1624
6
. .
22.
Berli
JU
,
Montgomery
JR
,
Segev
DL
,
Ratner
LE
,
Maley
WR
,
Cooper
M
.
Surgical management of early and late ureteral complications after renal transplantation: techniques and outcomes
.
Clin Transplant
.
2015
;
29
(
1
):
26
33
.
23.
Fonio
P
,
Appendino
E
,
Calandri
M
,
Faletti
R
,
Righi
D
,
Gandini
G
.
Treatment of urological complications in more than 1,000 kidney transplantations: the role of interventional radiology
.
Radiol Med
.
2014
;
120
(
2
):
206
12
. .
24.
Sabnis
RB
,
Singh
AG
,
Ganpule
AP
,
Chhabra
JS
,
Tak
GR
,
Shah
JH
.
The development and current status of minimally invasive surgery to manage urological complications after renal transplantation
.
Indian J Urol
.
2016
;
32
(
3
):
186
91
. .
25.
Latchamsetty
KC
,
Mital
D
,
Jensik
S
,
Coogan
CL
.
Use of collagen injections for vesicoureteral reflux in transplanted kidneys
.
Transplant Proc
.
2003
;
35
(
4
):
1378
80
. .
26.
Mastrosimone
S
,
Pignata
G
,
Maresca
MC
,
Calconi
G
,
Rabassini
A
,
Butini
R
, et al.
Clinical significance of vesicoureteral reflux after kidney transplantation
.
Clin Nephrol
.
1993
;
40
(
1
):
38
45
.
Available from: https://www.ncbi.nlm.nih.gov/pubmed/8358874 Accessed 2020 May 9
.
27.
Torricelli
FCM
,
Watanabe
A
,
Piovesan
AC
,
David-Neto
E
,
Nahas
WC
.
Urologic issues in pediatric transplant recipients
.
Transl Androl Urol
.
2019
;
8
(
2
):
134
40
. .
28.
Sarier
M
,
Callioglu
M
,
Yuksel
Y
.
The necessity of voiding cystourethrogram for the evaluation of recipient candidates in adult renal transplantation
.
Russ J Transplant Artif Organs
.
2020
;
22
(
1
):
35
9
. .
29.
Balaban
M
,
Özkaptan
O
.
Efficiency and safety of the sting operation on kidney transplanted patients with symptomatic vesicoureteral reflux and neurogenic bladder dysfunction
.
Transplant Proc
.
2020 Jan–Feb
;
52
(
1
):
191
5
. .
30.
Grünberger
T
,
Gnant
M
,
Sautner
T
,
Höbert
K
,
Steininger
R
,
Hofbauer
J
, et al.
Impact of vesicoureteral reflux on graft survival in renal transplantation
.
Transplant Proc
.
1993
;
25
(
1 Pt 2
):
1058
9
.
Available from: https://www.ncbi.nlm.nih.gov/pubmed/8442041 Accessed 2020 May 9
.
31.
Molenaar
NM
,
Minnee
RC
,
Bemelman
FJ
,
Idu
MM
.
Vesicoureteral reflux in kidney transplantation
.
Prog Transplant
.
2017
;
27
(
2
):
196
9
. .
32.
Gratzke
C
,
Pahde
A
,
Dickmann
M
,
Reich
O
,
Seitz
M
,
Jauch
K
, et al.
Predictive factors for urinary retention following kidney transplantation in male patients
.
Scand J Urol Nephrol
.
2012
;
46
(
1
):
44
7
. .
33.
Gökçe
AM
,
Kaya
C
,
Kara
VM
,
Ozel
L
,
Ruhi
C
,
Titiz
MI
.
Effects of urethral stricture on allografts in kidney transplantation
.
Transplant Proc
.
2015
;
47
(
5
):
1336
9
. .
34.
Sarier
M
,
Tekin
S
,
Duman
İ
,
Yuksel
Y
,
Demir
M
,
Alptekinkaya
F
, et al.
Results of transurethral resection of the prostate in renal transplant recipients: a single center experience
.
World J Urol
.
2018
;
36
(
1
):
99
103
. .
35.
Lubetzky
M
,
Ajaimy
M
,
Kamal
L
,
de Boccardo
G
,
Akalin
E
,
Kayler
L
.
Kidney transplant complications from undiagnosed benign prostatic hypertrophy
.
Clin Transplant
.
2015
;
29
(
6
):
539
42
. .
36.
Mitsui
T
,
Shimoda
N
,
Morita
K
,
Tanaka
H
,
Moriya
K
,
Nonomura
K
.
Lower urinary tract symptoms and their impact on quality of life after successful renal transplantation
.
Int J Urol
.
2009
;
16
(
4
):
388
92
. .
37.
Sarier
M
,
Duman
I
,
Demir
M
,
Yuksel
Y
,
Emek
M
,
Kukul
E
.
The outcomes of transurethral incision/resection of the prostate (TUIP/TURP) performed early after renal transplantation
.
Turk J Urol
.
2018
;
44
(
2
):
172
7
. .
38.
Reinberg
Y
,
Bumgardner
GL
,
Aliabadi
H
.
Urological aspects of renal transplantation
.
J Urol
.
1990
;
143
(
6
):
1087
92
.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/2188014 Accessed 2017 Mar 15
. .
39.
Mokos
I
,
Kastelan
Z
,
Basić-Jukić
N
,
Kes
P
,
Pasini
J
.
Transurethral incision/resection of the prostate (TUIP/TURP) in operative treatment of repeated bladder outlet obstruction early after kidney transplantation
.
Acta Clin Croat
.
2011
;
50
(
3
):
381
4
.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/22384774 Accessed 2017 Feb 13
.
40.
Sarier
M
,
Duman
I
,
Kilic
S
,
Yuksel
Y
,
Demir
M
,
Aslan
M
, et al.
Comparative results of transurethral incision with transurethral resection of the prostate in renal transplant recipients with benign prostate hyperplasia
.
Urol J
.
2018
;
15
(
4
):
209
13
. .
41.
Wong
KA
,
Olsburgh
J
.
Management of stones in renal transplant
.
Curr Opin Urol
.
2013
;
23
(
2
):
175
9
. .
42.
Verrier
C
,
Bessede
T
,
Hajj
P
,
Aoubid
L
,
Eschwege
P
,
Benoit
G
.
Decrease in and management of urolithiasis after kidney transplantation
.
J Urol
.
2012
;
187
(
5
):
1651
5
. .
43.
Delmonico
F
;
Council of the Transplantation Society
.
A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines
.
Transplantation
.
2005
;
79
(
6 Suppl
):
S53
66
.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/15785361 Accessed 2017 Nov 7
..
44.
Ganpule
A
,
Vyas
JB
,
Sheladia
C
,
Mishra
S
,
Ganpule
SA
,
Sabnis
RB
, et al.
Management of urolithiasis in live-related kidney donors
.
J Endourol
.
2013
;
27
(
2
):
245
50
. .
45.
Olsburgh
J
,
Thomas
K
,
Wong
K
,
Bultitude
M
,
Glass
J
,
Rottenberg
G
, et al.
Incidental renal stones in potential live kidney donors: prevalence, assessment and donation, including role of ex vivo ureteroscopy
.
BJU Int
.
2013
;
111
(
5
):
784
92
. .
46.
Schade
GR
,
Wolf
JS
,
Faerber
GJ
.
Ex-vivo ureteroscopy at the time of live donor nephrectomy
.
J Endourol
.
2011
;
25
(
9
):
1405
9
. .
47.
Sarier
M
,
Duman
I
,
Yuksel
Y
,
Tekin
S
,
Ozer
M
,
Yucetin
L
, et al.
Ex vivo stone surgery in donor kidneys at renal transplantation
.
Int J Urol
.
2018
;
25
(
10
):
844
7
. .
48.
Sarier
M
,
Callioglu
M
,
Yuksel
Y
,
Duman
E
,
Emek
M
,
Usta
SS
.
Evaluation of the renal arteries of 2,144 living kidney donors using computed tomography angiography and comparison with intraoperative findings
.
Urol Int
.
2020 May
;
104
(
7–8
):
637
40
. .
49.
Pearce
E
,
Clement
KD
,
Yallappa
S
,
Aboumarzouk
OM
.
Likelihood of distal ureteric calculi to pass spontaneously: systematic review and cumulative analysis of the placebo arm of randomized-controlled trials
.
Urol Int
.
2020 Sep
;
1
6
. .
50.
Coll
DM
,
Varanelli
MJ
,
Smith
RC
.
Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT
.
AJR Am J Roentgenol
.
2002
;
178
(
1
):
101
3
. .
51.
Sarier
M
,
Duman
I
,
Callioglu
M
,
Soylu
A
,
Tekin
S
,
Turan
E
, et al.
Outcomes of conservative management of asymptomatic live donor kidney stones
.
Urology
.
2018
;
118
:
43
6
. .
52.
Sarier
M
,
Duman
I
,
Yuksel
Y
,
Tekin
S
,
Demir
M
,
Arslan
F
, et al.
Results of minimally invasive surgical treatment of allograft lithiasis in live-donor renal transplant recipients: a single-center experience of 3,758 renal transplantations
.
Urolithiasis
.
2019
;
47
(
3
):
273
8
. .
53.
Dadkhah
F
,
Asgari
MA
,
Tara
A
,
Safarinejad
MR
.
Modified ureteroneocystostomy in kidney transplantation to facilitate endoscopic management of subsequent urological complications
.
Int Urol Nephrol
.
2010
;
42
(
2
):
285
93
. .
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