Uretero‐Neo‐Cystostomy in Renal Transplantation. Is An Antireflux Mechanism Mandatory?

Abstract

We report a retrospective analysis of 120 kidney transplantations in which a simple end-to-end ureteric implantation in the bladder without antireflux mechanism was made. From this study no greater incidence of vesico-ureteric reflux could be demonstrated and, even when present, reflux neither interfered with graft function nor caused an increased incidence of recurrent urinary tract infections. The incidence of other urological complications (leakage, obstruction) being equal, this very simple technique yielded in our hands the best results and we recommend its use in kidney transplantation.

Problems of the Distal Ureter in Renal transplantation

“…The choice of an antireflux procedure instead of a sim ple and nontunneling ureteroneocystostomy is still a mat ter of controversy, especially as there are other (nontech nical) causes for reflux to occur (chronic ureteric rejec tion, see later). Moreover, similar reflux rates have been reported after tunneling and nontunneling techniques of ureteroneocystostomy [15,29,43] (table 7). Basically, a tunneling procedure should provide some degree of reflux protection and therefore, theoretically, seems preferable in order to minimize the risk of ascending infection in the immunocompromized recipient.…”

“…While some authors suggest that reflux is deleterious to long-term graft function [15,28,42,43,70, 126] others did not confirm this finding [15. 23, 122], According to our opinion the mesangiocapillary lesions in graft recipients with reflux, described by Mathew et al [70], more probably represent the effect of coincident rejection than that of reflux itself, the renal lesions and reflux being the result of common immunological altera tions in the kidney and ureter.…”

“…Thus, reflux rates of 12.1 % were found after tunneling ureteroneocystostomy and 14.2% after nontunneling procedures [15]. Summarizing the re sults of table 7 with inclusion of the reports in which a clear description of the technique of ureteroneocystos tomy is given, this incidence of reflux is 25.9% (156/601) following ureteroneocystostomy with a tunnel technique and 24.6% (46/187) in ureteral implantation without tun nel.…”

“…Summarizing the re sults of table 7 with inclusion of the reports in which a clear description of the technique of ureteroneocystos tomy is given, this incidence of reflux is 25.9% (156/601) following ureteroneocystostomy with a tunnel technique and 24.6% (46/187) in ureteral implantation without tun nel. The lowest incidence of reflux using a tunnel for ure teral implantation was 0.9% (2/103) [3], the highest 79% (15/19) [29], the lowest without tunnel 3.6% (2/56) [15], the highest 88.9 (8/9) [89]. In an earlier report of the Hei delberg material [23] we examined 170 graft recipients with a mean duration of graft function of 4.1 ± 2.5 months and demonstrated reflux in 56 (32.9%).…”

Value of Routine Voiding Cystourethrography After Renal Transplantation

“…However, the actual impact of this condition has been a subject of ongoing debate (19,22,(26)(27)(28)(29)(30). To the best of our knowledge, this study is the largest series of deceased and living donor kidney allograft recipients in which the effect of early VUR on the incidence of UTI, rejection rates, and graft and patient survival was analyzed.…”