Modified extravesical ureteral reimplantation technique for kidney transplants.
OBJECTIVE
We describe a modification and evaluate a technique of extravesical ureteral reimplantation for kidney transplant.


METHODS
We reviewed the records of 120 kidney transplant recipients who underwent ureteral reimplantation via a modified extravesical technique. Follow-up evaluation included renal ultrasonography. Because reflux is not routinely assessed in transplant cases, only symptomatic reflux was considered a complication and accessed with voiding cystourethrography (VCUG). The urological complications evaluated included urinary fistula, ureteral stenosis and symptomatic vesicoureteral reflux.


RESULTS
The modified extravesical technique produced a successful result in 93.4% of patients with no symptomatic reflux or anastomotic obstruction. Anastomotic complications included stenosis in four patients, prolonged leakage and fistula in three patients, and symptomatic vesicoureteral reflux in one patient. Other urologic complications included complicated hematuria in three patients, postoperative urosepsis in one patient, and ureteral stenosis caused by extrinsic compression in three patients due to lymphocele (two patients) and by adhesions (one patient).


CONCLUSIONS
The modified extravesical ureteral reimplantation is a reliable procedure with predictable results comparable to those of more-traditional techniques and proved to be efficient without increasing the incidence of urological or anastomotic complications. This modified technique offers two advantages; removal of the ureteral stent with the urethral catheter without the need for a postoperative cystoscopy and facilitation of postoperative endoscopic maneuvers if needed.
Abou-Elela
Ashraf
A
Urology, Cairo University, 1, Obour Buildings, Salah Salem St., Ap. 12, Nasr City, Cairo, 35290, Egypt. ashrafaboelela@yahoo.co.uk
Morsy
Ahmad
A
Reyad
Ihab
I
Torky
Mohamed
M
Meshref
Alaa
A
Barsoum
Rashsad
R
D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D012092:Replantation / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*