Endoscopic management of urologic complications following renal transplantation: impact of ureteral anastomosis.
OBJECTIVE
To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis.


METHODS
From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment.


RESULTS
Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy (n = 21) or after Politano-Leadbetter anastomosis (n = 22). The success rate of endoscopic management was 75% (n = 16) for Politano-Leadbetter anastomosis versus 53% (n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference (P = .1).


CONCLUSIONS
Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.
Tillou
X
X
Service d'Urologie-Transplantation, CHU Sud, Avenue Laennec, 80000 Amiens, France. xavtillou@hotmail.com
Raynal
G
G
Demailly
M
M
Hakami
F
F
Saint
F
F
Petit
J
J
D003559:Cystostomy / Q000379:methods; D004724:Endoscopy / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors; D014513:Ureter / Q000601:surgery; D014515:Ureteral Diseases / Q000453:epidemiology / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000601:surgery; D014546:Urinary Catheterization / Q000379:methods; D014570:Urologic Diseases / Q000175:diagnosis* / Q000453:epidemiology*