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

Abstract

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.

Urological complications in renal transplantation: impact of a change of technique

“…We found the cystotomy to be responsible for a large proportion of the leaks when the LP technique was used Seventeen major complications occurred in the LP group (12%), comprising six urine leaks (4%), five of and this finding is consistent with that in published series [10,11,14]. We also consider the cystotomy to be these presenting in the first week.…”

“…and simple to perform [1, [12][13][14]. These techniques have theoretical and practical advantages over that described Details of the characteristics of each group are given in Table 1.…”

Value of Routine Voiding Cystourethrography After Renal Transplantation

“…This is in accordance with previously published data reporting an incidence of VUR as high as 86% in asymptomatic patients after renal transplantation (15,22). However, previous studies performed VCUG merely per-indication or in selected patient cohorts.…”

“…Conflicting data have been reported regarding the associations between VUR and renal function (11)(12)(13). Some reports suggest that urinary tract infections (UTIs) compromise renal allograft survival (14)(15)(16)(17), but the impact of VUR on the risk of developing UTI is less certain (18). In addition, the effect of VUR on graft and patient survival remains unclear, and studies evaluating short-term survival rates have revealed inconsistent results (19)(20)(21)(22).…”

“…The median interval between renal transplantation and VCUG was 24 days (IQR: [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The VCUG study results were reviewed and graded by an independent radiologist and urologist (23).…”