If a patient has hydronephrosis in the immediate postoperative period following renal transplant, would you place a stent or nephrostomy tube?

The answer depends on the degree of hydronephrosis and whether there is obstruction. Is creatinine increasing? Immediately after transplant, recovery of ureteral peristalsis is delayed, and the collecting system may dilate somewhat. There may also be edema at the uretero-vesical junction that needs time to resolve. If the renal pelvis continues to dilate and/or the creatinine increases, a percutaneous nephrostomy with a contrast nephrostogram will be definitive. Trying to place a stent across the UVJ may damage the anastomosis if done too soon after transplant (first month or two).