Intravesical Versus Extravesical Ureteroneocystostomy in Kidney Transplantation: A Systematic Review and Meta-Analysis

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Introduction: From the several techniques for facilitating urinary continuity of the transplanted kidney, the ureteroneocystostomy appears to be most widely accepted and is associated by the least number of complications. Nevertheless, urological complications are still a major problem postoperatively with a reported incidence in up to 30%, associated with significant morbidity, mortality, prolonged hospital stay and high medical costs. There is no evidence to conclude if an extravesical or intravesical approach is superior to the other. This review and meta-analysis was carried out to investigate whether there is a technique for the ureteroneocystostomy that is to be preferred. Methods: Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library. Reference lists were searched manually. The methodology was in accordance with the PRISMA statement. Results: Two randomized controlled trials and seventeen cohort studies were identified. Based on the meta-analysis, outcome was in favour of the extravesical anastomosis, including a relative risk (RR) of stenosis of 0.67 (confidence interval (CI) 0.48-0.93; p=0.02), of leakage 0.55 (CI 0.39-0.80; p=0.001) of total number of urological complications 0.56 (CI 0.41-0.76; p=0.0002) and of haematuria 0.41 (CI 0.22-0.76; p=0.005). Conclusion: Based on these results there is evidence in favour of the extravesical ureteroneocystostomy technique for decreased urological complications in kidney transplantation.