title: Comparative urologic complications of ureteroneocystostomy in kidney transplantation: transvesical Leadbetter-Politano versus extravesical Lich-Gregoir technique.
abstract: BACKGROUND
  The incidence of urologic complications after kidney transplantation remains high despite improvements in diagnosis and operative techniques. Urinary tract reconstruction is usually done by ureteroneocystostomy (UCNS), and several techniques are available. In this study, we evaluated the outcomes of 2 different UCNS techniques performed in our department, the transvesical Leadbetter-Politano (L-P) and the extravesical Lich-Gregoire (L-G) technique.
  
  
  METHODS
  We evaluated the outcomes of 2 different UCNS techniques, L-P versus L-G, performed in our department between July 1, 2006, and December 31, 2011. During this period, we performed 524 consecutive renal transplantations-264 cases using the L-P technique (50.3%) and 260 cases with L-G technique (49.7%). Renal grafts were obtained from cadaveric donors in 146 cases (27.86%) and from living-related donors in 378 cases (72.14%). Recipient mean age was 35.64 years and the male to female ratio was 1.63:1.
  
  
  RESULTS
  Urologic complications after kidney transplantation occurred in 22 cases in the L-P UCNS group (8.33%). The most common complications were ureteral stenosis (3.41%) and leakage (2.65%). Other complications recorded were lymphoceles (1.89%) and hematoma with secondary ureteral obstruction (0.38%). Compared with the L-P UCNS technique, the L-G technique was associated with fewer overall complications (6.15% vs 8.33%; P = .06), a lesser rate of ureteral stenosis (2.31% vs 3.41%; P = .08), and a similar rate of leakage. However, statistical analysis revealed no differences between the 2 techniques (P = .06). In addition, we did not note any differences in graft and patient survival between the 2 groups.
  
  
  CONCLUSIONS
  In our study, the extravesical L-G technique has a lower complication rate compared with transvesical L-P procedure, but without statistical differences. Furthermore, the L-G technique is easier and faster to perform, it avoids a separate cystotomy, and requires a shorter ureteral length. In conclusion, we recommend L-G technique as technique of choice in kidney transplantation.
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: C
authors: C
authors: Baston
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania. Electronic address: mihai.harza@gmail.com.
authors: M
authors: M
authors: Harza
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: A
authors: A
authors: Preda
authors: Center of Internal Medicine-Nephrology, Fundeni Clinical Institute, Bucharest, Romania.
authors: I
authors: I
authors: Gener
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: I
authors: I
authors: Manea
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: S
authors: S
authors: Voinea
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: V
authors: V
authors: Olaru
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: B
authors: B
authors: Badescu
authors: Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
authors: I
authors: I
authors: Sinescu
mesh_terms: D000328:Adult; D002102:Cadaver; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014519:Ureterostomy / Q000009:adverse effects* / Q000379:methods; D014570:Urologic Diseases / Q000150:complications / Q000175:diagnosis*