Presiding Officer Training module 2024 lok sabha elections
Renal transplant complicatons copy
1.
2. • Urologic complications occur in 4%–8% of patients, and
vascular complications occur in approximately 1%–2% .
• Urologic Complications:
• Urine Leak and Urinomas
• rare complications.
• Extravasation of urine may occur from the renal pelvis, ureter,
or ureteroneocystostomy site.
• Urinomas vary in size and common during first 2
postoperative weeks.
• Can be seen in rare sites such as the scrotum or thigh
3. • ULTRASOUND
• well-defined, anechoic fluid collection with no septations that increases in
size rapidly.
• Radionuclide scan:
• extravasation of radiotracer
• Delayed scintigrams should be obtained, since accumulation of radiotracer
may be slow.
• Antegrade pyelography:
• site of origin of the urinoma and in planning appropriate intervention.
• Differential diagnosis:
• seroma or lymphocele
• Rx:
• Drainage and Ureteral stents must be kept in place for 6–8 weeks after
cessation of leakage.
4.
5.
6.
7. • Urinary obstruction :
• 2% of transplantations and common in first 6
months.
• Most frequent site - implanted ureter into the
bladder.
• Rx:
• Percutaneous nephrostomy to relieve obstruction
and ureteral stent placement and balloon
ureteroplasty to be done.
8.
9. • Percutaneous nephrostomy is used to relieve
obstruction and allow the deployment of
other radiologic interventions such as ureteral
stent placement and balloon ureteroplast
10. • Peritransplant Fluid Collections:
• It includes urinomas , hematomas, lymphoceles and
abscesses.
• Occurs in upto 50% of transplantations.
• Urinomas and hematomas - immediately.
• lymphoceles - 4–8 weeks.
11. • Hematoma:
• USG:
• Acute hematoma - echogenic.
• Older hematoma - even appear anechoic, more closely
resembling fluid and septations.
• CT: acute hematoma - high-attenuation components
• older hematoma - liquefied and serous portions of
intermediate attenuation
• MRI: acute hematoma - show high signal intensity with
both T1 and T2
12.
13. • Lymphoceles:
• common peritransplant fluid collections with a
prevalence of 0.5%–20%.
• They may develop at any time, from weeks to
years after transplantation.
14. • US, lymphoceles are anechoic and may have
septations. Similar to other peritransplant fluid
collections, they can become infected and can
develop a more complex appearance (Fig 8). At
CT, lymphoceles have variable characteristics and
are usually sharply circumscribed. Their CT
attenuation values are typical of those of water
and usually lower than those of recent
hematomas and abscesses. Radionuclide and MR
imaging studies are helpful for excluding the
presence of urine and blood, respectively.
Editor's Notes
due to ureteral necrosis caused by vascular insufficiency or increased urinary pressures caused by obstruction.
may be performed with US guidance, higher creatinine level of the fluid compared with its serum concentration
secondary to ischemia or rejection, by technical error during the ureteroneocystostomy, or by kinking, more than 90% in distal third of the ureter
Retrograde pyelogram shows the area of narrowing at the site of ureteral implantation into the bladder (
iagnostic aspiration -rule out abscess formation. However, percutaneous drainage of the entire fluid collection is often neither efficacious (due to its multiloculated nature) nor advisable because of the self-limited nature of the complication and risk of infection.
Subcapsular hematoma (a) US image demonstrates an isoechoic subcapsular fluid collection (arrows). (b) CT scan shows a heterogeneous crescentic subcapsular collection in the transplanted kidney secondary to hematoma (arrows).
