Comparison of Surgical Correction Techniques for Post-Renal Transplantation Vesicoureteral Reflux.
BACKGROUND
Symptomatic urinary tract infection (UTI) after renal transplantation (RT) is an important morbidity in transplant recipients and may cause pyelonephritis and sepsis. Surgical correction of high-grade vesicoureteral reflux (VUR) after RT is suggested, performing ureteral reimplantation or pyelo-ureteral/uretero-ureteral anastomosis. Recently, extravesical seromuscular tunnel lengthening techniques have been reported with favorable results and low complication rates.


METHODS
We retrospectively reviewed the charts of 38 patients with post-transplantation VUR who underwent reflux correction surgery. Patient characteristics were analyzed to compare our extravesical seromuscular tunnel lengthening technique with uretero-ureteral and pyelo-ureteral anastomosis techniques.


RESULTS
Twenty patients were treated with the extravesical approach (group I) and 18 patients by pyelo-ureteral or uretero-ureteral anastomosis with the use of native ureter (group II). Mean operative time was significantly shorter in group I than in group II (64.8 vs 110.1 min; P < .05), and mean duration of hospital stay after the operation also was shorter in group I (1.5 vs 5.1 d; P < .05). We determined persistent VUR in postoperative voiding cystouretrography in 2 patients (10%) in group I, but there was regression in VUR grades of all of the patients. There was no significant difference in postoperative number of UTI episodes and serum creatinine levels between the 2 groups.


CONCLUSIONS
Extravesical seromuscular tunnel lengthening is an effective and safe technique for post-transplantation VUR management.
Organ Transplantation Center, Goztepe Medical Park Hospital, Istanbul, Turkey; Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey. Electronic address: drturunc@hotmail.com.
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Turunç
Organ Transplantation Center, Goztepe Medical Park Hospital, Istanbul, Turkey.
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Eroğlu
Organ Transplantation Center, Goztepe Medical Park Hospital, Istanbul, Turkey; Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey.
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Tabandeh
Department of Urology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey.
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Erol
D002675:Child, Preschool; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D066027:Transplant Recipients; D014513:Ureter / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000209:etiology* / Q000601:surgery*