Surgical Urological Complications: Analysis and Management of 1525 Consecutive Renal Transplantations G. Zavos, P. Pappas, T. Karatzas, N.P. Karidis, J. Bokos, K. Stravodimos, E. Theodoropoulou, J. Boletis, and A. Kostakis ABSTRACT Urological complications after renal transplantation increase morbidity, delay graft function, and occasionally lead to graft and/or patient loss. The aim of this study was to analyze the causes of and therapeutic approaches to urological complications in renal transplantation as they related to patient outcomes. A series of 1525 consecutive renal transplantations were performed over a 24-year period. Renal grafts were obtained in 814 cases from living-related and in 711 from cadaveric donors. A Lich-Gregoire ureterovesical reimplantation technique with minimal bladder wall dissection was employed in all cases. Ureteral stents were routinely used in cadaveric transplants and exceptionally among living-related grafts. Urological complications were classified according to the mechanism and site of urinary tract involvement: graft ureteropelvic junction obstruction/stenosis (A), ureteral obstruction/stenosis (B), ureterovesical anastomosis obstruction/stenosis (C), urinary leakage (D), and other (E). Overall, we encountered 96 urological complications (6.3%). Group C complications occurred in 29 cases (30.2%), followed by 27 cases (28.1%) for group B patients, 25 cases (26.0%) for group D, 12 cases (12.5%) for group A, and 3 cases (3.1%) for group E patients. Surgical intervention was required in 49 (51.0%) of all urological complications. The others (n = 47, 49.0%) were treated either conservatively or by minimally invasive procedures. A rapid diagnosis of urological complications, assisted by early posttransplant DTPA scans, routine ultrasonography, and especially prompt treatment, resulted in compensation of renal graft dysfunction in the vast majority (n = 90, 93.8%) of cases. Surgical techniques of graft retrieval and reimplantation are of utmost importance to minimize the incidence of urological complications. From the Transplantation Unit (G.Z., J.B.), Laiko General Hospi- tal, Athens, Greece; Department of Radiology (P.P.), Laiko General Hospital, Athens, Greece; Second Propaedeutic Depart- ment of Surgery (T.K., N.P.K., A.K.), University of Athens, Med- ical School, Athens, Greece; Department of Urology (K.S.), University of Athens, Medical School, Athens, Greece; and Department of Nephrology (E.T., J.B.), Laiko General Hospital, Athens, Greece. Address reprint requests to Theodore Karatzas, Assistant Professor of Surgery, University of Athens, Medical School, 17, Ag. Thoma str, 11527, Goudi, Athens, Greece. E-mail: tkaratz@ med.uoa.gr 0041-1345/08/$–see front matter © 2008 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2008.03.103 360 Park Avenue South, New York, NY 10010-1710 1386 Transplantation Proceedings, 40, 1386 –1390 (2008)