title: Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis.
abstract: No consensus exists about which ureterovesical anastomosis technique to use for kidney transplantation. The aim of this systematic review was to compare the existing techniques in relation to the risk of urological complications. All studies that compared ureterovesical anastomotic techniques in kidney transplantation were included. Study endpoints were urinary leakage, ureteral stricture, vesicoureteral reflux and hematuria. Subanalyses of stented and nonstented techniques were performed. Two randomized clinical trials and 24 observational studies were included. Meta-analyses were performed on the Lich-Gregoir (LG) versus Politano-Leadbetter (PL) techniques and LG versus U-stitch (U) techniques. Compared with the PL technique, the LG technique had a significantly lower prevalence of urinary leakage (risk ratio (RR): 0.47, 95% confidence interval (CI): 0.30 to 0.75) and a significantly lower prevalence of hematuria when compared with both PL and U techniques (RR: 0.28, 95% CI: 0.16 to 0.49 and RR: 0.23, 95% CI: 0.11 to 0.50, respectively), regardless of ureteral stenting. There was no difference in the prevalence of ureteral strictures or vesicoureteral reflux between the various techniques. Of the three most frequently used ureterovesical anastomotic techniques, the LG technique results in fewer urological complications than the PL and U techniques.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Victor P
authors.initials: VP
authors.lastname: Alberts
authors.forename: Mirza M
authors.initials: MM
authors.lastname: Idu
authors.forename: Dink A
authors.initials: DA
authors.lastname: Legemate
authors.forename: Maria P
authors.initials: MP
authors.lastname: Laguna Pes
authors.forename: Robert C
authors.initials: RC
authors.lastname: Minnee
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D013536:Suture Techniques; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods
keywords: renal transplantation; surgical complications; surgical techniques; systematic review and ureterovesical anastomosis