Nephrostomy Drainage for Renal Transplant Complications

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Abstract
The use of temporary diverting nephrostomy drainage in the management of immunosuppressed renal transplant patients with supravesical urinary extravasation, fistulas or ureteral obstruction is reviewed. In a literature survey covering an 11 yr interval and 4307 tranplants there were 204 cases (4.7 %) of ureteral extravasation or fistula and 113 cases (2.6%) of ureteral obstruction. Attempts at urologic repair in these 317 cases resulted in a 30.9% failure rate (98 cases), of which 86.7% (85 cases) occurred in patients without nephrostomy compared to 13.3% (13 cases) in patients with nephrostomy. In 255 consecutive renal transplant patients there were 7 (2.7%) with ureteral extravasation or fistula and 14 (5.5%) with ureteral obstruction. Temporary nephrostomy was done in all 21 patients to protect the urologic repair and, when necessary, to control sepsis and allow for patient stabilization before delayed urinary tract reconstruction. In this series there was no mortality and only 1 renal unit (4.7%) was lost as a consequence of urologic complications. The use of nephrostomy in transplant patients with ureteral extravasation, fistulas or ureteral obstruction is encouraged strongly to optimize patient and renal unit survival.