Modified ureteroneocystostomy in kidney transplantation to facilitate endoscopic management of subsequent urological complications

Abstract

Urological complications in kidney transplant patients are among serious complications. Endourology has allowed for a less-invasive approach to dealing with these transplant complications. Access to the upper urinary tract in traditionally anterior extravesical ureteroneocystostomy is usually difficult if not impossible. We evaluated the results of renal transplantation comparing two techniques of anterior extravesical ureteroneocystostomy (AEVUNC) and posterolateral extravesical ureteroneocystostomy (PLEVUNC). A total of 120 transplant recipients were randomized to either PLEVUNC (group 1, n = 61) or AEVUNC (group 2, n = 59) techniques. Ureteral and nonureteral complications were compared at 36- to 51-month follow-up. The data regarding successful ureteroscopy were also gathered. The PLEVUNC group had a urological complication rate of 27.9%, which did not significantly differ from those in AEVUNC group (26.1%) (P = 0.1). In the PLEVUNC group, 1- and 3-year graft survivals were 92.6 and 85.2%, respectively, whereas in the AEVUNC group they were 92.3 and 82.7%, respectively (P = 0.08). There were no significant differences between urinary tract infections, delayed graft function, and chronic allograft nephropathy between the two groups (P = 0.1, 0.1 and 0.08, respectively). Three patients (5.6%) in PLEVUNC group and 1 (1.9%) in AEVUNC group developed immediate postoperative hydronephrosis after removal of ureteral stent (P = 0.04). Successful ureteroscopy was achieved in 52 (96.3%), and 39 (75%), of patients in PLEVUNC and AEVUNC groups, respectively (P = 0.001). Easy and safe access to the upper urinary tract in transplant recipients can be achieved using a PLEVUNC technique. This facilitates the endoscopic procedures in the case of urological complications and disorders.