Kidney transplant ureteroneocystostomy: comparison of full-thickness vs. Lich-Gregoir techniques.
Despite a variety of urinary tract reconstructive techniques, urinary complications are the most frequent technical adverse event following kidney transplantation. We examined outcomes of two ureteroneocystostomy techniques, the full-thickness (FT) technique and the Lich-Gregoir (LG) technique in 634 consecutive kidney-alone transplants (327 FT and 307 LG) between December 2006 and December 2010. Urological complications at one yr post-transplantation occurred in 27 cases (4.3%) including 16 ureteral strictures (2.5%), four ureteral obstructions (0.6%) owing to donor-derived stones or intrinsic hematoma, and seven urine leaks (1.1%). Compared with LG, the FT technique was associated with similar proportions of ureteral complications overall (3.9% vs. 4.6%, p = 0.70), ureteral strictures (3.7% vs. 1.3%, p = 0.08), urinary stones/hematoma (1.0% vs. 0.3%, p = 0.36), and overall urinary leaks (1.6% vs. 0.6%, p = 0.22); however, the FT technique was associated with somewhat fewer urine leaks at the ureterovesical junction (0% vs. 1.3%, p = 0.05). There were no differences between the two groups in terms of length of stay, delayed graft function, urinary tract infection with the first post-transplant year, estimated glomerular filtration rate, and overall graft and patient survival. The FT technique of ureteroneocystostomy is technically simple to perform and has a similar incidence of urinary complications compared with the LG technique.
Department of Surgery, Montefiore Medical Center, Bronx, NY, USA. liisekayler@yahoo.com
Liise
L
Kayler
Ivan
I
Zendejas
Ernesto
E
Molmenti
Poorvi
P
Chordia
Denise
D
Schain
Joseph
J
Magliocca
D000328:Adult; D016022:Case-Control Studies; D003559:Cystostomy / Q000401:mortality*; D051799:Delayed Graft Function / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D014515:Ureteral Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D014519:Ureterostomy / Q000401:mortality*