A nipple-valve technique for ureteroneocystostomy in pediatric kidney transplantation.
The ureteroneocystostomy in kidney transplantation can be performed with a variety of techniques. Over a 20-yr period, we utilized a technique of nipple-valve ureteroneocystostomy for the pediatric kidney transplants performed at our institution. The distal ureter is everted upon itself and anchored in place with four interrupted sutures to create a nipple valve, which is then inserted into the bladder and sewn mucosa-to-mucosa with the same sutures. The muscularis layer is closed around the ureter without tunneling and without routine ureteral stenting. After 109 transplants, patient survival was 97.2, 97.2, and 86.9% at one, five, and 10 yr, respectively. Graft survival was 91.7, 71.7, and 53.9% at one, five, and 10 yr, respectively. The most common cause of graft loss was acute or chronic rejection, seen in 75% of those experiencing graft loss. Two patients (1.8%) developed pyelonephritis in the transplanted kidney. Nipple-valve ureteroneocystostomy in pediatric kidney transplantation is a safe and simple method for performing the ureterovesical anastomosis with a low rate of pyelonephritis after transplantation.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kyle J
KJ
Van Arendonk
Seth D
SD
Goldstein
Jose H
JH
Salazar
Komal
K
Kumar
Henry T
HT
Lau
Paul M
PM
Colombani
D000293:Adolescent; D002648:Child; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D014519:Ureterostomy / Q000379:methods*
pediatric kidney transplantation; surgery; surgical complications; ureter; vesicoureteral reflux