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Urinary Fistula After Kidney Transplant — Management

Ureteral complications (leaks and strictures) occur in 1–15% of renal transplants, with distal ureteral ischemia as the primary cause.[1][2] See clinical page: Urinary Fistula After Kidney Transplant.

Conservative / Percutaneous Management​

Percutaneous nephrostomy with or without antegrade double-J stenting can provide definitive management in approximately 62% of fistulas presenting beyond 72 hours post-transplant, particularly when contrast passage into the bladder is demonstrated. Antegrade stent placement is safe and effective, especially for early and ureteroneocystostomy-site leaks.[3][4]

Surgical Repair​

Required in the majority of cases (~80%). Options:

  • Re-do ureteroneocystostomy.
  • Ureteroureterostomy using the native ureter.
  • Boari flap with psoas hitch for extensive defects.
  • Pyelo-/ureteroureterostomy (> 90% success).
  • Pedicled omentum wrapping of the anastomosis is a useful adjunct for recurrent fistulas.[1][2]

Native-to-graft ureteroureterostomy may reduce fistula incidence compared to standard ureteroneocystostomy (1.5% vs 4.1%).[2]

References​

1. Novacescu D, Abol-Enein H, Latcu S, et al. Ureteric complications and urinary tract reconstruction techniques in renal transplantation: a surgical essay. J Clin Med. 2025;14(12):4129. doi:10.3390/jcm14124129

2. Nie ZL, Zhang KQ, Li QS, et al. Treatment of urinary fistula after kidney transplantation. Transplant Proc. 2009;41(5):1624–6. doi:10.1016/j.transproceed.2008.10.103

3. Alcaraz A, Bujons A, Pascual X, et al. Percutaneous management of transplant ureteral fistulae is feasible in selected cases. Transplant Proc. 2005;37(5):2111–4. doi:10.1016/j.transproceed.2005.03.118

4. Bhagat VJ, Gordon RL, Osorio RW, et al. Ureteral obstructions and leaks after renal transplantation: outcome of percutaneous antegrade ureteral stent placement in 44 patients. Radiology. 1998;209(1):159–67. doi:10.1148/radiology.209.1.9769827