Urinary reconstruction after kidney transplantation: pyeloureterostomy or ureteroneocystostomy
Department of Surgery
Adult; Aged; Cystostomy; Female; Humans; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Ureter; Ureterostomy
Hepatology | Surgery | Surgical Procedures, Operative | Urology
PURPOSE: Ureteroneocystostomy (UCN) is the most widely used urinary reconstruction technique during kidney transplantation. Disadvantages of this technique include a high incidence of hematuria and reflux, plus the potential for obstruction resulting from distal ureteral fibrosis. Pyeloureterostomy (PU) avoids these complications but increases the technical complexity.
METHODS: Between January 1990 and December 2005, 1066 adults patients underwent kidney transplantations; 768 patients (72.1%) had urinary reconstruction by PU and 298 (27.9%) underwent UNC.
RESULTS: Patients in the PU group underwent simultaneous ipsilateral native nephrectomy. The operative time was longer in the PU group compared with the UNC group: 210 +/- 36 min versus 182 +/- 24 min (P < 0.001). Overall surgical complications in the PU group were comparable to those in the UNC group (9.5% versus 12.3%). The urinary complication rate was also comparable in both groups: 3.2% (25 of 768) in the PU group and 5% (15 of 298) in the UNC group. However, urinary obstruction comprised 60% of urinary complications in the UNC group, compared with 32% in the PU group (P < 0.01). We treated most urinary complications non-operatively. However, 24% of patients (six of 25) in the PU group needed operative intervention or revision for ureteral reconstruction, compared with 46.6% (seven of 15) in the UNC group (P < 0.01).
CONCLUSIONS: Pyeloureterostomy is a safe and effective method for urinary tract reconstruction in renal transplantation. Pyeloureterostomy should be part of every transplant surgeon's armamentarium.
DOI of Published Version
J Surg Res. 2013 May 1;181(1):156-9. doi: 10.1016/j.jss.2012.05.043. Link to article on publisher's site
The Journal of surgical research
Saidi, Reza F.; Elias, Nahel; Hertl, Martin; Kawai, Tatsuo; Cosimi, A. Benedict; and Ko, Dicken S., "Urinary reconstruction after kidney transplantation: pyeloureterostomy or ureteroneocystostomy" (2013). University of Massachusetts Medical School Faculty Publications. 55.