title: Ureteral reconstruction after renal transplantation: clinical outcome and risk factors.
abstract: BACKGROUND
  The incidence of urological complications after renal transplantation ranges from 2.5 to 30%. Often surgical revision is necessary. The risk factors for surgical revision and which surgical techniques to apply are not elucidated. This study investigates the outcome and risk factors for surgical revision of the ureterocystostomy.
  
  
  METHODS
  Between January 1995 and March 2009, 1,157 consecutive kidney transplantations were performed. All patient charts and surgical reports were reviewed.
  
  
  RESULTS
  Urological complications occurred in 142 (12.3%) patients. In 60 patients (5.2%) surgical revision was necessary. Of these 60 patients, 43 (71.7%) received neoureterocystostomy, 10 (16.7%) ureteropyelostomy reconstruction and 7 (11.7%) other techniques. Independent risk factors for surgical revision were donor ureteral reconstruction (odds ratio (OR) 48.66, 95% confidence interval (CI) 5.01-472.97), recipient age <18 years (OR 4.85, 95% CI 1.50-15.72) and delayed graft function (OR 2.70, 95% CI 1.36-5.36). Ureteral stenting was a protective factor for surgical revision (OR 0.30, 95% CI 0.12-0.81). The urological complication rates after neoureterocystostomy, ureteropyelostomy reconstruction and other techniques were 16, 0 and 0%, respectively. The overall surgical success rate was 92%.
  
  
  CONCLUSIONS
  Ureteral stenting, recipient age, delayed graft function and perioperative ureteral reconstruction are significant factors associated with surgical revision of the ureterocystostomy. Surgical revision of the ureterocystostomy is a successful therapy with a low recurrence rate.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: V P
authors.initials: VP
authors.lastname: Alberts
authors.forename: R C
authors.initials: RC
authors.lastname: Minnee
authors.forename: F J
authors.initials: FJ
authors.lastname: Bemelman
authors.forename: K A M I
authors.initials: KA
authors.lastname: van Donselaar-van der Pant
authors.forename: P
authors.initials: P
authors.lastname: Laguna Pes
authors.forename: M M
authors.initials: MM
authors.lastname: Idu
mesh_terms: D000293:Adolescent; D000328:Adult; D003559:Cystostomy / Q000009:adverse effects*; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014519:Ureterostomy / Q000009:adverse effects*; D014570:Urologic Diseases / Q000209:etiology* / Q000601:surgery; D055815:Young Adult