title: Comparison of Urologic Complications Between Ureteroneocystostomy and Ureteroureterostomy in Renal Transplant: A Meta-Analysis.
abstract: Transplant surgeons use a myriad of ureteral anastomotic techniques in renal transplant. Although the Lich-Gregoir extravesical anastomosis is the most common, ureteroureterostomy also is used. In this meta-analysis, our objective was to compare the complication rates of these 2 techniques as reported in the literature.
  
  
  
  A systematic review of the literature revealed 44 articles, 6 of which met our inclusion criteria. Studies were compiled using Review Manager (RevMan version 5.3, Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, Denmark). Forest plots were generated to assess relative risk. A fixed-effects model was used for low heterogeneity, and a random-effects model was used for high heterogeneity.
  
  
  
  Overall complications were similar for both procedures (relative risk, 1.22; 95% confidence interval, 0.9-1.65), as were rates of urine leak and fistula (relative risk, 0.79; 95% confidence interval, 0.17-3.64) and hematuria (relative risk, 0.24; 95% confidence interval, 0.001-4.84). Stricture, obstruction, and stone formation were more common after ureteroureterostomy (relative risk, 0.63; 95% confidence interval, 0.45-0.88), whereas vesicoureteral reflux (relative risk, 6.82; 95% confidence interval, 1.68-27.61) and urinary tract infection (relative risk, 2.29; 95% confidence interval, 1.3-4.03) were more common after ureteroneocystostomy.
  
  
  
  With similar overall complication rates, both procedures can be viewed as being acceptable primary anastomotic techniques. In light of differing individual complication rates and the scarcity of data comparing the 2 methods, no specific recommendation regarding that technique should be used can currently be elucidated. We believe that further prospective studies comparing ureteroneocystostomy and primary ureteroureterostomy may reveal which is superior regarding complication rates.
authors.affiliation: From the Department of Urology, University of Toledo Medical Center, Toledo, OH, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Suttle
authors.forename: David
authors.initials: D
authors.lastname: Fumo
authors.forename: Ziya
authors.initials: Z
authors.lastname: Baghmanli
authors.forename: Barbara
authors.initials: B
authors.lastname: Saltzman
authors.forename: Jorge
authors.initials: J
authors.lastname: Ortiz
mesh_terms: D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D003559:Cystostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014519:Ureterostomy / Q000009:adverse effects* / Q000379:methods