title: Lich-Gregoir technique and routine use of double J catheter as the best combination to avoid urinary complications in kidney transplantation.
abstract: BACKGROUND
  Urinary complications in kidney transplantation cause patient morbidity and can decrease graft survival. Most of the complications stem from the vesicoureteric anastomosis. Different techniques for ureteroneocystostomy (UNC) have been designed to avoid these complications. The routine use of a double J catheter after the anastomosis has the same purpose. Our aim was to show our experience and compare the use or non-use of a double J catheter and different techniques for ureteric reimplantation with the rate of urologic complications.
  
  
  METHODS
  We conducted a retrospective, nonrandomized study of 1011 renal transplantations performed between July 1985 and April 2012. We recorded the surgical techniques for UNC, the use or non-use of a double J catheter, and urinary complications (ureteric fistulae and strictures). The first 700 kidney transplantations (group A) were performed using several UNC techniques (Taguchi, Leadbetter-Politano, and Lich-Gregoir) with a selective use of double J catheter according to the criteria of the surgeon. In the last 311 patients (group B), a surgical technique was established (Lich-Gregoir), as well as the universal use of double J catheters.
  
  
  RESULTS
  Urinary fistula occurred in 7% of group A patients and 2% of group B patients (P = .0001). Ureteric stricture occurred in 5.3% of patients in group A and 3% of group B patients (P = .09). In our study, routine prophylactic stenting combined with the Lich-Gregoir UNC technique has decreased the incidence of postoperative fistulae.
  
  
  CONCLUSIONS
  Individually, the use of double J catheters seems to lessen the incidence of fistulae, although statistically, the difference is not significant. Accurate knowledge of the complications rates, recommendations of guidelines, and the early diagnosis are essential to attaining reasonable results in kidney transplantation.
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain. Electronic address: crismomed@gmail.com.
authors: C
authors: C
authors: Moreno-Alarcón
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: P
authors: P
authors: López-Cubillana
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: P Á
authors: PÁ
authors: López-González
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: A
authors: A
authors: Prieto-González
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: J C
authors: JC
authors: Ruiz-Morcillo
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: E H
authors: EH
authors: Olarte-Barragán
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: C P
authors: CP
authors: Pinzón-Navarrete
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: P F
authors: PF
authors: Gutiérrez-Gutiérrez
authors: Urology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors: G
authors: G
authors: Gómez-Gómez
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods*; D057785:Catheters; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology; D014570:Urologic Diseases / Q000517:prevention & control*