Long-term comparative outcomes between 2 common ureteroneocystostomy techniques for renal transplantation.
OBJECTIVE
We compared the incidence of ureteral complications between the classic (Lich-Gregoir) technique and the recently popularized single stitch (Shanfield) technique in renal transplantation.


METHODS
The charts of 721 consecutive transplant recipients from May 1999 to July 2002 were retrospectively reviewed. Ureteral and nonureteral complications were reviewed at 3 to 5-year followup.


RESULTS
Of the 721 recipients evaluated 713 were included in the study. There were 360 recipients in the Lich-Gregoir group and 353 in the Shanfield group. A significantly higher rate of ureteral complications occurred in the Shanfield group compared to the Lich-Gregoir group (15.6% vs 3.9%, p <0.0001). The Shanfield group consisted of 20 patients with ureteral leakage, 21 with hematuria, 11 with strictures and 3 who had ureteral stones. The Lich-Gregoir group had 8 patients with ureteral leakage, 5 with hematuria and 1 with a stricture. In comparison, urinary tract infections, delayed graft function and rejection rates were not significantly different between the 2 groups (p = 0.76, 0.12 and 0.19, respectively).


CONCLUSIONS
In contrast to other reports, the Shanfield group had significantly more ureteral complications. In particular the Shanfield technique may predispose patients to higher rates of hematuria and stone formation. Based on this large series and published meta-analyses we believe that the stented Lich-Gregoir anastomosis is the superior ureteroneocystostomy technique in renal transplantation.
Veale
Jeffrey L
JL
Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095, USA. jveale@mednet.ucla.edu
Yew
Jay
J
Gjertson
David W
DW
Smith
Craig V
CV
Singer
Jennifer S
JS
Rosenthal
J Thomas
JT
Gritsch
H Albin
HA
D000328:Adult; D003559:Cystostomy; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000453:epidemiology / Q000209:etiology*; D014519:Ureterostomy