Abstract:

BACKGROUND: The high incidence of urinary fistula following renal transplantation not only influence on wound healing, but also result in local or systemic infection, even renal allograft loss or death. Therefore, it is necessary to establish a standard for diagnosing and treating of urinary fistula.
OBJECTIVE: To retrospectively analyze the diagnosis and treatment of urinary fistula following renal transplantation in 95 cases.
METHODS: In 95 cases, there were 59 males and 36 females, aged from 19 to 61 years, urinary fistula occurred at days 1-40 after renal transplantation, including 74 simple fistulas and 21 complex fistulas. Besides of our clinical experiences and routine methods, the “five-step procedure protocol” for diagnosis and treatment of urinary fistula reported by Li Qian-sheng was also referred.
RESULTS AND CONCLUSION: Totally 56 cases were managed by conservative treatment, 45 of whom were cured. 50 cases (including 11 cases those failed to cure by conservative treatment) were managed by surgical treatment, 45 of whom were cured. Of the remaining 5 cases, 2 grafts were removed because of graft rupture and massive hemorrhage caused by uncontrolled acute rejection, and 3 recipients died of severe pneumonia shortly after transplantation. 71 of the 90 cases were received long-term follow up, ranging 2 to 11 years. Of the simple urinary fistula cases, 56 were on regular follow up; 41 kept a normal graft function, 10 were diagnosed of chronic allograft nephropathy, 4 returned to hemodialysis and 1 died of lung cancer. Of the complicated ones, 15 were on regular follow up. 8 kept a normal graft function, 4 were diagnosed of chronic allograft nephropathy, and 3 returned to hemodialysis. The design of “five-step procedure protocol” makes urinary fistula diagnosis and treatment more ordered and standard, which can obtain excellent therapeutic efficiency.