[Urological complications after kidney transplantation from extended criteria donors: Ureteroneocystostomy versus pyelo-ureterostomy].
BACKGROUND
The use of transplants from extended criteria donors increases the number of urological complications after renal transplantation. Two different anastomosis techniques used to restore urinary continuity are compared in this study.


METHODS
Retrospective study, bi-center over a period of 5 years. One hundred and seventy six patients operated at Hospices Civils de Lyon benefited from ureteroneocystostomy according to De Campos-Freire (group 1) and 167 patients operated at the Necker Hospital in Paris had a pyelo-ureterostomy (group 2). The various urological complications (fistulas, strictures, seromas, haematomas and vesico-ureteric reflux) and their care were compared. Risk factors were sought.


RESULTS
The waiting time before transplantation was longer in group 2 than in group 1 (51 and 33.84 months) as the percentage of anuric patients (52.9 % against 32.9 %) (P<0.001). The cold ischemic time was shorter in group 1 (939.3minutes on average against 1325.3minutes for group 2) (P<0.001). A double J stent was put in place in 97.6 % of cases in group 2 against 84.2 % for group 1 (P<0.001). We did not find any significant difference in the occurrence of stenosis and fistulas (major complications) between the 2 groups. There were more minor complications (hematoma, seroma and vesico-ureteric reflux) in group 1 (P=0.033). There was a difference in the treatment of these complications, especially stenosis (P=0.024) with a significantly more conservative approach in group 2. Multivariate analysis found anuria, sex of recipients and donor age as independent risk factors in the onset of complications and the double J stent as a protective factor.


CONCLUSIONS
This study does not demonstrate the superiority of a urinary anastomosis technique. The establishment of a double J stent reduces the risk of complications. Analysis of risk factors allows to propose a decision tree to guide the surgical strategy, particularly in the population of anuric recipients.


METHODS
5.
Service d'urologie et de chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, université Claude-Bernard Lyon 1, 5, place d'Arsonval, 69003 Lyon, France. Electronic address: xavprom@hotmail.com.
X
X
Promeyrat
Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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L
Alechinsky
Service d'urologie et de chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, université Claude-Bernard Lyon 1, 5, place d'Arsonval, 69003 Lyon, France.
R-C
RC
Duarte
Service d'urologie et de chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, université Claude-Bernard Lyon 1, 5, place d'Arsonval, 69003 Lyon, France.
X
X
Martin
Centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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P
Paparel
Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France.
M-O
MO
Timsit
Service d'urologie et de chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, université Claude-Bernard Lyon 1, 5, place d'Arsonval, 69003 Lyon, France.
L
L
Badet
D000367:Age Factors; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001002:Anuria / Q000150:complications; D003559:Cystostomy; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014019:Tissue Donors; D014519:Ureterostomy; D014570:Urologic Diseases / Q000209:etiology / Q000601:surgery*
Anastomoses chirurgicales; Anuria; Anurie; Complications chirurgicales; Kidney transplantation; Surgical anastomosis; Surgical complications; Transplantation rénale