The patient was counseled regarding both non-operative and operative approaches and he agreed to proceed with surgery. The nephrostomy tube was removed. The patient was discharged 4 days post-operatively with plans to remove the stent cystoscopically in 4 weeks. Ureteral complications remain one of the most common surgical complications of renal transplantation. Late complications are usually strictures.
Ureteral ischemia can result in early ureteral necrosis with leak or present late as a stricture.
The distal ureter of the transplant is particularly vulnerable to ischemia because of the nature of its blood supply. Arterial supply to the ureter arising from the gonadal artery or the iliac arteries is interrupted in the procurement process. The sole blood supply to the ureter now arises from the ureteral branches of the renal artery. Perfusion of the most distal segment of the transplant ureter, therefore, is potentially inadequate and ischemic complications may arise. At transplantation, the ureteral anastomosis is performed after the vascular anastomoses.