Endoscopic Management of Urologic Complications Following Renal Transplantation: Impact of Ureteral Anastomosis

Abstract

Objective To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis. Patient and methods From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment. Results Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy ( n = 21) or after Politano-Leadbetter anastomosis ( n = 22). The success rate of endoscopic management was 75% ( n = 16) for Politano-Leadbetter anastomosis versus 53% ( n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference ( P = .1). Conclusion Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.