Comparison of Surgical Correction Techniques for Post–Renal Transplantation Vesicoureteral Reflux

Turunç, V.; Eroğlu, A.; Tabandeh, B.; Erol, Ali

doi:10.1016/j.transproceed.2017.01.039

Cited by 4 publications

(5 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As described by Turunç, V., et al, [10] , median serum creatinine before VUR correction was 1.4 mg/dL (range, 0.8-4.3) and was 1.2 mg/dL (range, 0.7-4.5) after peration with no significant difference, but in this present study, median serum creatinine before VUR correction was 1.2mg/dL (range, 0.4-5.5), while after VUR management was 1mg/dL (range, 0.4-5.5), P value= 0.001, this significance can be explained by that we didn't correct only reflux but we did optimization and bypass measures for LUT defunctionalization but in their puplication they did correction for reflux only in optimal LUT condition [10] .…”

Section: Discussionmentioning

confidence: 93%

“…It is our institution protocol to use antireflux ureteral anastomosis by Lich-Gregoir technique and stenting the ureter in all cases at time of Tx. Also, we did Lich-Gregoir Redo ureteroneocystotomy in 10(15.5%) cases of total 66 cases, while in a study was done by Turunç, V., et al, [10] who used extra vesicalsero muscular tunnel lengthening technique with at least 3 cm tunnel length in 20(52.6%) cases of 38 cases and there was no difference regarding follow up VCUG, (18(90%) patients resolution by grade in that study, the same as our study results, 9 of 10 cases (90%) resolution in our study. In the previous study, they did anastomosis to native ureter (uteterouretrostomy) in18 patients with a percentage 47.4%, that we didn't use it at all as most of native kidneys in our pediatrics were nephroctomized and it isn't in our institution protocol to use the native ureter in anastomosis.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Renal Graft Vesicoureteral Reflux Survival and Oucome in Pediatric Recipients; Single Centre Experience

El-Ghany

Gawad

Esmaeel

et al. 2020

Minia Journal of Medical Research

View full text Add to dashboard Cite

Objective:The goal of this study was to evaluate pediatric post transplant vesicoureteral reflux (VUR) in terms of graft's Urinary Tract Infections (UTIs) episodes, graft outcome and survival in comparison to grafts that don't have reflux. Subjects and Methods: A total of 145 pediatric patients who underwent kidney transplantation at our transplantation unit between 2008 and January 2019 and suited our inclusion criteria were included in this retrospective cohort study and a voiding cystourethrography (VCUG) was done to them and categorized into main groups; group (A) refluxing graft group (n=66) and group (B) non refluxing graft group (n=79). Baseline donor and recipient demographic characteristics, post transplant serum creatinine level at different points, graft outcome, and UTIs were listed. Post transplantation (Tx) UTIs and graft outcome were compared between both groups. Glomerular Filtration Rate (GFR) was measured using Shwartz formula. Frequency-Volume Chart (FVC) and UroDynamic Study (UDS) were used to identify Lower urinary Tract (LUT) condition and helped us regarding decision making in management of graft VUR. Results: Mean ±SD age at time of Tx was 8.7±3.4y in group A versus 8.9±2.8y in group B, P value=0.667. Regarding sex, 46 patients (69.7%) were male in group A, while 56(70.9%) were male in group B, p value = 0.876. UTI occurrence was similar between groups {40(60.6%) patients in group A versus 49 (62%) patients in group B, P value=0.861 but UTIs episodes (more than 3 episode per year) was 20 (30.3%) patients in group A versus 1(1.3%) patient, P value =0.001. Both groups were similar in terms of 5-year (100% versus 98.5%), and 10-year (76.2% versus 84.7%) graft survival. Conclusions: There was no difference between refluxing and non refluxing graft in terms of UTIs occurrence, graft function and survival. Frequency of UTI episodes was more in the refluxing graft like any native kidney primary VUR.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 98%

Renal Graft Vesicoureteral Reflux Survival and Oucome in Pediatric Recipients; Single Centre Experience

El-Ghany

Gawad

Esmaeel

et al. 2020

Minia Journal of Medical Research

View full text Add to dashboard Cite

show abstract

“…VUR is a risk factor defined for post-transplantation recurrent and symptomatic UTI. It may cause acute pyelonephritis and reflux nephropathy as in the primary reflux disease (21) . In long-term, the effect of urinary tract infections on the graft functions is not known exactly.…”

Section: Discussionmentioning

confidence: 99%

Posttransplantation Vesicoureteral Reflux in Renal Grafts and Their Outcomes in Pediatric Transplantation: Should We Be Afraid ?

Alaygut¹,

Soyaltın²,

Öncel³

et al. 2021

Terh

View full text Add to dashboard Cite

Objective: Demographical, pre-transplantation and post-transplantation features and post-treatment results of four pediatric cases, who had vesicoureteral reflux (VUR) in the graft kidney, were discussed. Methods: Transplantation age, primary diagnosis, VUR to pretransplantation in native kidneys, history of bladder dysfunction, bladder capacity, results of urodynamic studies, donor and its features, induction treatments and ongoing immunosuppressive treatments, acute rejection episodes, CMV and BK infections, VUR grade in the renal graft, DMSA results, treatment type and its outcomes, and the renal graft functions of four patients who underwent kidney transplantation at Tepecik Training and Research Hospital between 2008 and 2016 and for whom VUR was determined via voiding cystourethrography (VCUG) due to recurrent urinary tract infections, were evaluated. Results: All of four cases were female. Their mean transplantation age was 8.7 years (5-16). High grade (Grade 4) VUR was determined in the graft kidney in all but one. DMSA included multiple scar foci apart from one case having low grade VUR. Cases were primarily treated endoscopically and then by open surgery. Spontaneous recovery occurred in one case. Graft dysfunction was not observed in any of the cases. Conclusion: VUR is an important risk factor in recurrent urinary tract infections after post-transplantation. A special assessment should be done for the patient in the presence of VUR and conservative and surgical treatments should be executed together. It should be remembered that VUR can be spontaneously regressed by the bladder capacity increasing treatments and prophylaxis.

show abstract

“…When a suitable native ureter is not available, a new uretero-cystostomy is performed using the transplant ureteral stump, possibly adopting the Politano-Leadbetter technique [12]. It is also worth mentioning the technique proposed by Turunça et al, which consists of an extra-vesical seromuscular tunnel lengthening [37]. This procedure aims to increase the length of the seromuscular tunnel to more than 3 cm to cover the distal segment of the transplanted ureter.…”

Section: Management Of Post-transplant Vurmentioning

confidence: 99%

“…This procedure aims to increase the length of the seromuscular tunnel to more than 3 cm to cover the distal segment of the transplanted ureter. Comparison between tunnel lengthening, uretero-ureterostomy, and pyelo-ureteral anastomosis have shown lower surgical complication and recurrent UTIs rates, better allograft function, shorter operative times and hospital stays following tunnel lengthening [37]. Overall, excellent results have been described after reconstructive surgery, regardless of the specific technique chosen for ureteral reimplantation.…”

Section: Management Of Post-transplant Vurmentioning

confidence: 99%

Allograft Vesicoureteral Reflux after Kidney Transplantation

et al. 2022

View full text Add to dashboard Cite

Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues.

show abstract

Comparison of Surgical Correction Techniques for Post–Renal Transplantation Vesicoureteral Reflux

Cited by 4 publications

References 18 publications

Renal Graft Vesicoureteral Reflux Survival and Oucome in Pediatric Recipients; Single Centre Experience

Renal Graft Vesicoureteral Reflux Survival and Oucome in Pediatric Recipients; Single Centre Experience

Posttransplantation Vesicoureteral Reflux in Renal Grafts and Their Outcomes in Pediatric Transplantation: Should We Be Afraid ?

Allograft Vesicoureteral Reflux after Kidney Transplantation

Contact Info

Product

Resources

About