Uretero-neocystostomy in a swine model of kidney transplantation: a new technique.
BACKGROUND
Swine constitute a well-characterized large animal model for kidney transplantation (K-Tx) although the uretero-neocystostomy represents a crucial aspect because of the very small caliber of the ureter and the mucosal susceptibility to the edema during surgical management. Besides infectious and occlusive complications limited the employment of a stent and the peculiar anatomy of the species prevents its removal without an operative approach. These features find an equivalent in children (<4 year old) candidates to urological surgery. We investigated an uretero-neocystostomy technique to be applied in case of narrow caliber without using endoluminal device.


METHODS
Thirty unrelated large-white piglets, divided into three equal groups (n = 10) on the basis of the uretero-neocystostomy technique used, underwent K-Tx while receiving a double immunosuppressive regimen. We developed a direct uretero-neocystostomy (Direct) technique and compare this with the gold standard Lich-Gregoir (LG) and Leadbetter-Politano (LP) techniques.


RESULTS
After 60 days, the ureteral complication rates were: group 1 (LG): 60% (6/10, three early and three late strictures); group 2 (LP): 40% (4/10, two leakages, one early stricture, and one isolated ureteral dilatation); group 3 (Direct): 10% (1/10, one isolated ureteral dilatation). No bacterial cystitis or nephritis occurred; retrograde cystograms were negative for refluxes in every group.


CONCLUSIONS
The comparison between the old techniques and the new one (LG and LP versus Direct) showed a lower incidence of complications among the animals that underwent the new direct technique (P < 0.05). This technique could be applied clinically in selected pediatric cases either of transplantation or reflux.
Zonta
Sandro
S
Department of Surgery--School of Medicine, Surgical Experimental Laboratories, University of Pavia, and Epato-Pancreatic Surgery Unit, IRCCS Pol. San Matteo, Pavia, Italy. sandrozonta@hotmail.com
Lovisetto
Federico
F
Lorenzo
Cobianchi
C
Abbiati
Francesca
F
Alessiani
Mario
M
Dionigi
Paolo
P
Zonta
Aris
A
D000818:Animals; D049628:Body Size; D003559:Cystostomy / Q000379:methods*; D005240:Feasibility Studies; D006084:Graft Rejection / Q000453:epidemiology; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods*; D023421:Models, Animal; D011183:Postoperative Complications / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D013552:Swine; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*