Should routine pyeloureterostomy be advocated in adult kidney transplantation? A prospective study of 283 recipients.
OBJECTIVE
Ureteroneocystostomy surgical techniques have been repeatedly debated in the medical literature, in contrast to pyeloureterostomy, which is merely considered a salvage procedure. We assessed urological complications and their management after routine pyeloureterostomy in adult kidney transplantation cases.


METHODS
We performed a 2-center, uncontrolled, prospective study from January to December 2007. We compared results in 151 consecutive kidney transplantations with routine pyeloureterostomy (group 1) and in 129 procedures with extravesical anti-reflux ureteroneocystostomy (group 2). Perioperative ureteral stenting was done on demand in each group. Major complications included complex leakage, stenosis and surgical revision. Transient leakage or obstruction less than 15 days in duration were considered minor complications.


RESULTS
Recipients in group 1 were more likely to undergo ureteral stenting on demand than those in group 2 (68.9% vs 21.7%). The incidence of overall complications was similar in groups 1 and 2 (9.3% and 13.2%, respectively, p = 0.15), although the major complication rate was higher in group 2. Group 1 recipients had a tendency to require long-term ureteral stenting more often. The only recipient with ureteral necrosis in group 1 was treated with surgical resection and repeat end-to-end ureteroureterostomy. In each group no graft was lost due to urological complications or their management.


CONCLUSIONS
Routine pyeloureterostomy is a safe technique that may be a valuable alternative to ureteroneocystostomy for adult renal transplantation. It does not preclude further open re-intervention. Its main advantages include a significant decrease in the risk of surgical re-intervention, the opportunity to perform further endourological procedures on the allograft urinary system and the avoidance of vesicoureteral reflux.
Timsit
Marc-Olivier
MO
Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. marc-olivier.timsit@nck.aphp.fr
Lalloué
Fanny
F
Bayramov
Araz
A
Taylor
Melissa
M
Billaut
Claire
C
Legendre
Christophe
C
Kreis
Henri
H
Badet
Lionel
L
Méjean
Arnaud
A
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014519:Ureterostomy; D014570:Urologic Diseases / Q000209:etiology / Q000601:surgery*; D055815:Young Adult