Traitement chirurgical du reflux congenital et du méga-uretère primaire

Grégoir, W

doi:10.1159/000279647

Cited by 14 publications

(6 citation statements)

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“…The extravesical ureteroneocystostomy is commonly referred to as a Lich-Gregoir anastomosis (8,9), though the theory behind this anastomosis likely began as early as 1896 with Witzel (10). Variations have been suggested by others including Sampson (11), Woodruff (12), Konnack (13), McDonald (14) and Barry (15).…”

Section: Introductionmentioning

confidence: 99%

Stented versus Nonstented Extravesical Ureteroneocystostomy in Renal Transplantation: A Metaanalysis

Mangus

Haag

2004

American Journal of Transplantation

192

113

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Stenting of the extravesical ureteroneocystostomy in renal transplantation is controversial. This study is a metaanalysis of 49 published studies over 30 years time in which the extravesical technique was used. Stented and nonstented anastomoses were compared. One-hundred six articles published between 1973 and 2002 were reviewed and 49 met criteria for inclusion. Articles were required to list original, numeric, previously unpublished data and to report or to describe the use of an extravesical ureteroneocystostomy, with or without stent. Data were analyzed within separate groups, (1) randomized, controlled trials and (2) case series. Data were included from five randomized, controlled trials and 44 case series. In the controlled trials group, there were urologic complications in 6 of 407 stented (1.5%), and 35 of 389 nonstented subjects (9.0%) (p < 0.0001, OR 0.24, 95% CI 0.10-0.57). In the case-series group, there were urologic complications in 137 of 4245 stented (3.2%) and 433 of 9077 nonstented subjects (4.8%) (p = 0.007, OR 0.58, 95% CI 0.39-0.86). Renal transplants with stented extravesical ureteroneocystostomy have a significantly lower urologic complication rate than those with nonstented anastomoses. All five randomized, controlled trials individually found stented anastomoses to have a lower complication rate and this was confirmed by metaanalysis of these trials and of case-series data.

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Section: Introductionmentioning

confidence: 99%

Stented versus Nonstented Extravesical Ureteroneocystostomy in Renal Transplantation: A Metaanalysis

Mangus

Haag

2004

American Journal of Transplantation

192

113

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“…However, even with this technique the frequency of fistulas ranges from 1 to 25% [5][6][7][8][9][10][11][12][13]. In the most recent literature, several authors have advocated use of the Gr6goir and Lich procedure [14,15], which avoids the complications of a cystotomy and at the same time provides an antireflux mechanism by a submucosal tunnel. We have compared the results of these two techniques with regard to the frequency of the two serious urologic complications, fistula and stenosis of the ureter.…”

mentioning

confidence: 99%

Ureterocystostomy in renal transplantation: Comparison of endo‐ and extravesical anastomoses

et al. 1977

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Among 241 renal transplants with implantation of the ureter into the urinary bladder, the endovesical technique of Politano and Leadbetter (PL) was used in 108 cases and the extravesical technique of Grégoir and Lieh (GrL) was used in 133. Urinary fistulas occurred in 10 patients (9.3%) with the PL technique and in only 1 patient (0.8%) with the GrL technique. The difference was highly significant (p<0.01). Stenosis of the ureter developed in 3 patients (2.8%) following the PL technique and in 9 patients (6.8%) after the GrL technique, an insignificant difference (p>0.10). None of the complications resulted in death or failure of transplantation. It is concluded that the extravesical technique of Grégoir and Lich is the best method of avoiding urinary leakage, which is the most dangerous urologic complication of kidney transplantation.

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“…Firstly, the renal vein was anastomosed to the external iliac vein, followed by the renal artery that was anastomosed to the external iliac artery. Then, an extravesical ureteroneocystostomy was performed, as described by Lich-Gregoir [10,11]. The detrusor muscle was closed over the anastomosis with one or two interrupted absorbable sutures to create a submucosal tunnel, with an antireflux mechanism.…”

Section: Surgical Techniquementioning

confidence: 99%

Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: a noninferiority randomized controlled trial, SPLINT trial

et al. 2020

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The role of ureteral stents in living-donor kidney transplantation remains uncertain. In this randomized controlled trial (SPLINT), we compared urological complications in living-donor kidney transplantations performed with or without stents. We included 200 consecutive patients that received living-donor kidney transplantations at the Erasmus MC, University Medical Center, Rotterdam. Patients (124 males, 76 females, mean age 54 AE 13) were randomized for suprapubic externalized single J stents (N = 100) or no stent (N = 100). The primary outcome was the probability of a percutaneous nephrostomy insertion (PCN) during a 12-month follow-up. To assess whether no stenting is noninferior to stenting, we allowed the probability of a PCN to increase by at most 5% (this is the noninferiority margin). Baseline characteristics were comparable between groups. In the no-stent group, there were more PCN insertions, 14% (95% CI 4.3-23.7%); urinary leakages, 12% (95% CI 5.4-21.3%); and surgical re-interventions because of urological complications, 8% (95% CI 1.5-14.5%). The stent group had more hematuria, 26% (95% CI 13.1-38.9%); and graft rejections, 15% (95% CI 2.7-27.3%). Patients in both groups had similar mean GFRs at several time points. Besides a better Euro-Qol-5D in the no-stent group at 2 and 6 weeks postoperative, similar quality of life was reported based on SF-36 and Euro-Qol-5D scores. In this trial, noninferiority has not been demonstrated for no-stent placement in relation to the number urological complications.

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Traitement chirurgical du reflux congenital et du méga-uretère primaire

Cited by 14 publications

References 0 publications

Stented versus Nonstented Extravesical Ureteroneocystostomy in Renal Transplantation: A Metaanalysis

Stented versus Nonstented Extravesical Ureteroneocystostomy in Renal Transplantation: A Metaanalysis

Ureterocystostomy in renal transplantation: Comparison of endo‐ and extravesical anastomoses

Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: a noninferiority randomized controlled trial, SPLINT trial

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