Objective:We summarized the therapeutic results of 68 differently located urinary fistulae after kidney transplantation in order to approach optimal treatments for them. Methods: Between December 1994 and July 2008

fistulae were observed in 68 of 1263 patients (5.4%) after kidney transplantation

including 26 lower fistulae and 42 upper fistulae. The former included vesical fistulae and stoma fistulae

while the latter included ureter fistulae

pelvis fistulae.The location of fistulae was determined by cystography

magnetic resonance hydrography(MRH) or operation research. In both groups we first adopted conservative treatment which was placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in

however

if invalid

we resorted to surgical repair. Subsequently

therapeutic efficacies of differently located fistulae observed. Results: Twenty of 26 lower fistulae(76.9%) were cured successfully by conservative treatment For the remaining 6 cases(23.1%)

we had to turn to open surgery

among which 5 were cured and 1 underwent nephrectomy because of acute rejection. Only 8 of 42 upper fistula(19.0%)were cured by conservative treatment

but the other 34(81.0%)cases accepted open surgery among which 29 were cured

and 3 underwent nephrectomy owing to acute rejection (1 case)and failure of surgery(2 cases)

and 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae(76.9% vs. 19.0%

P<0.01). Conclusion: It is necessary to determine the location of urinary fistula after kidney transplantation. We can first adopt conservative treatment for lower fistulae

and only if invalid can we consider open surgery. For upper fistulae

it is wise to select open surgery.