Management of Urine Leak Following Renal Transplantation: An Evidence-Based Approach

Renal transplantation [RT] is associated with a significant rate of surgical complications which contribute to patient morbidity and can result in graft loss. Urological complications occur in 9% of RT and account for a significant proportion of surgical problems. They are thought to be related to the quality of the ureterovesical anastomosis and that of the donor ureter. Urological problems can occur in the early postoperative period [most often comprising of urinary leaks and ureteric obstruction/compression] or occur late [mainly comprising of ureterovesical anastomosis stenosis or vesicoureteric reflux]. From a clinical perspective, an elevated drain output in the early postoperative phase should alert to the possibility of a surgical complication [including haematoma, lymphocele or urinary fistula]. Biochemical analysis of the drain fluid is vital to confirm the diagnosis of urinary fistula. Imaging studies including ultrasonography, computed tomography and cystography can be helpful in diagnosis although the gold standard diagnostic test is a nephrostomy and antegrade pyeloureterogram if the graft is hydronephrotic. About two thirds of patients can be successfully treated with maximal decompression [catheter/drain/nephrostomy with or without stenting]. However, failures of this approach or large volume leaks require open exploration and reconstruction. Keywords: Renal Transplantation; Complication; Urinary Fistula