Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically. 1. Introduction The incidence of end-stage renal disease in the United States is 360 individuals per million population per year, and over 870,000 people currently live with the disease [1]. More than 40 billion dollars were allocated to end-stage renal disease (ESRD) in 2009 [1]. By the end of 2009 nearly 400,000 ESRD patients were managed with dialysis and 172,553 had functioning kidney transplants [1]. The 5-year survival rate for patients with a functioning renal transplant is markedly better than that for individuals on dialysis (85.5% versus 35.8%) and the costs of dialysis are nearly three times those of transplantation [1]. Despite the survival and cost benefit, a significant number of kidney transplant recipients experience urologic complications. Streeter et al. reviewed 1535 consecutive renal transplants and noted the following complications: ureteral obstruction (3.0%), urinary leak (2.9%), bladder outlet obstruction (1.1%), and obstructive ureteral calculi (0.3%) [2]. Mean recipient age was 43 years. Vesicoureteral reflux and urinary
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