Ureteroneocystostomy Technique Research Articles

Full-thickness Ureteroneocystostomy in Kidney Transplant: Evaluation of Complications and Graft Survival Outcomes at a High-volume Center

Objectives: To report a large series where the full-thickness (FT) technique was applied and evaluate infectious and functional outcomes and compare these to the available literature. The ureteroneocystostomy technique of kidney transplantation has great variability. Kidney transplants performed at our institution use the FT technique as opposed to most centers. Ureteroneocystostomy performed without an anti-reflux mechanism (without tunneling) may increase the risk of acute renal graft pyelonephritis (AGPN) and thus compromise graft survival. Methods: Retrospective cohort study, based on 1275 medical records of kidney transplanted patients between 2007 and 2018. The outcomes were renal graft survival, ureteral complications, and occurrence of AGPN. Kaplan-Meier’s analysis is used to describe estimated time averages and variability through the Log-Rank test. Poisson regression model is used to estimate multivariable prevalence ratios. Results: We found that renal graft survival rates were comparable to those found in the literature. The AGPN rate in our series was 12.53 episodes/100 patient-years, like other series in the literature. The ureteral complications rates are also similar. Our limitations were the impossibility to compare our results with a controlled group and the limited data underlying pathologies, rejection, and type of immunosuppression. Conclusions: The FT technique has survival outcomes and complications comparable to those of the Lich-Gregoir (LG) technique. The FT technique is simple and quicker to perform than LG and is a suitable alternative for ureteroneocystostomy for kidney transplant procedure.

236.12: Selective Ureteric Stenting Is Non-inferior to Routine Stenting for Major Urological Complications Following Renal Transplant in Low-Risk Patients

Introduction: Major urological complications (MUC) are a significant source of morbidity following a renal transplant occurring in up to 4% of cases. At our institution it has been standard practice to routinely place a J-J ureteric stent across the ureteroneocystostomy at the time of transplant. Meta-analysis has shown reduced incidence of MUC in randomised-controlled trials of stenting with a number needed to treat of 14 to prevent 1 MUC. Despite the potential benefits of routine stenting, evidence suggests there may be no statistical difference between routine vs. selective stenting for low-risk patients in terms of complications such as urinary leak and ureteric obstruction suggesting equipoise for this sub-group. Also, stenting itself is associated with several complications and increased costs such as urinary tract infection (UTI), BK virus and the need to retrieve the stent through flexible cystoscopy. We hypothesised that in select low-risk patients not stenting would be non-inferior to routine stenting in the remainder of our patients. Study design: After local ethics approval, our prospective observational cohort study was run between June 2017 and June 2021. In this period 380 consecutive renal transplants were performed at our centre. 30 patients were excluded who had dual kidney (including paediatric en bloc) transplant, early graft loss not related to a MUC, duplex ureter in the donor or an intra-peritoneal implantation. Following this, 350 transplants were included for analysis, 240 were stented and 110 were not. Primary outcomes were MUC and UTI and secondary outcome was the incidence of BK viraemia. All transplants used the same technique for ureteroneocystostomy, the Lich-Gregoir anti-refluxing anastomosis. The same 3 surgeons performed or directly supervised each transplant. The decision of whether to stent was at the discretion of each surgeon based on suggested criteria. Stenting was suggested for multiple donor renal arteries, technically difficult surgery, high risk (e.g. obese) patients or surgeon concerns regarding the ureteric anastomosis. A 5Fr Cook UniversaTM ureteric stent was used when stenting was performed. Patients were followed from transplant for a minimum of 6-months. Results: MUC occurred in 6.25% of stented vs. 7.2% of the not stented groups. These included early (<10 days) and late urinary leak, haematuria requiring washout, hydronephrosis requiring nephrostomy and stent encrustation. Observed rates of urinary tract infection (28.7% vs. 26.3%) and BK viraemia (8.7% vs. 8.1%) were similar between groups. Conclusions: In our cohort of 350 renal transplants, selectively stenting low-risk patients did not result in a higher rate of MUC. Rates of UTI or BK viraemia were not significantly different. Finally, not needing to remove a stent in our selective group was associated with savings of an estimated $165,000 AUD over 3 years with no statistically significant difference in complications.

Long-Term Results of Posterolateral Extravesical Ureteroneocystostomy and its Comparison with the Conventional Anterior Extravesical Ureteroneocystostomy Method in the Management of Urologic Complications in Kidney Transplant Patients.

Urological complications are common and serious in kidney transplant patients. Correct diagnosis of urological complications and rapid intervention are very important to maintain the transplanted organ. Using endoscopic methods and rapid access to ureteral orifice can be effective in treatment and management of urological complications in transplant patients. In this retrospective cohort study, 934 medical records of kidney transplant patients who underwent surgery through Posterolateral Extravesical Ureteroneocystostomy (PLEVUNC) and anterior extravesical ureteroneocystostomy (AEVUNC) techniques from 2011 to 2018 were evaluated. The outcomes of PLEVUNC and AEVUNC techniques were evaluated in 461 and 473 transplant patients, respectively. The patients were followed up for 60 months. Immediate and delayed complications, urological complications requiring endoscopic intervention, duration of access to ureteral orifice, as well as ureteroscopic and endoscopic outcomes were evaluated. The mean and ± SD (standard deviation) age of patients in PLEVUNC and AEVUNC groups were 46.2 7± 2.7 years and 47.3 ± 3.6 years, respectively. Urinary leakage and UTI were the most common immediate (7% and 6.2%) and delayed (5.5% and 5.5%) complications in both groups, respectively. The time to find ureteral orifice in patients requiring endoscopic intervention was significantly shorter in PLEVUNC group 3.5±1.2 compared with the AEVUNC group 10 ± 4.5 (P <.001). In 100% of PLEVUNC group and 62.6% of AEVUNC group, ureteral orifice of transplanted kidney was observed (P <.001). Ureteroscopy was reported successful in 94.5% and 37.4% of patients in PLEVUNC and AEVUNC groups, respectively. Easy and safe access to the ureteral orifice and to the upper urinary tract in transplant recipients can be achieved with the PLEVUNC technique. In case of urological complications this method facilitates endoscopy.

A Stentless Modified Lich-Gregoir Technique for Safe Early Bladder Catheter Removal in Living and Deceased Kidney Transplants

To describe a stentless modified Lich-Gregoir technique (mLG) for ureteroneocystostomy in renal transplantation (RT), with early bladder catheter (BC) removal (under 48 hours), and compare the postoperative results with those of the traditional technique (LG) with routine bladder catheter removal (4 to 5 days). The modification consists of maintaining a thin layer of detrusor fibers covering the bladder mucosa during dissection, which is incorporated into the anastomosis to reinforce the ureteroneocystostomy. This retrospective cohort study compared the postoperative outcomes of 100 consecutive patients who underwent mLG with early removal of BC between October 2018 to November 2019 with those of a historical cohort of 165 consecutive patients transplanted using stentless LG and routine removal of BC, who underwent surgery between July 2017 and September 2018. All transplants were performed by the same surgeon. Follow-up was 6 months. Demographic characteristics were comparable, although patients in the mLG group had a higher mean preoperative urine volume (911 ± 753.8mL vs 629 ± 638.6mL, P =.016). Patients in the mLG group successfully underwent early BC removal (2.2 ± 0.9 vs 4.8 ± 4.8 days, P <.001), with no differences in the incidence of surgical or clinical complications, including urine leaks (1% vs 3%, P =.284). In addition, mLG patients presented a shorter mean length of hospital stay (6.5 ± 5.0 vs 7.1 ± 6.2 days, P =.023). This stentless modified Lich-Gregoir technique enables safe early bladder catheter removal and is associated with reduced hospital length of stay.

Development of ureteroneocystostomy in pediatric population: ten years of experience from Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia

Background: Ureteroneocystostomy is one of the most common surgery in pediatric urology. The procedure can be performed either laparoscopically or in open surgery fashion. Currently, there is limited data available regarding the outcome of pediatric ureteroneocystostomy in Indonesia. The aim of this study is to evaluate the efficacy and safety of pediatric ureteroneocystostomy in both laparoscopic and open surgery techniques in one of the largest referral hospitals in Indonesia.Methods: This is a retrospective study in which all patients with age of 18 or below underwent ureteroneocystostomy in Cipto Mangunkusumo general hospital was included in ten years period. The outcome analyzed was the patients' demographic profile, procedure duration, blood loss, and length of stay of the patients.Results: A total of 46 patients underwent ureteroneocystostomy from year 2010 to 2020 with 38 patients underwent open surgery and 8 patients underwent laparoscopic surgery. The median age of the patients was 5 years old, which predominantly female (60.9%). The most common urology condition was vesicoureteral reflux and ectopic ureter at 34.8%. The median procedure duration was significantly shorter in the open surgery than laparoscopic group (180 and 325 minutes, respectively; p=0.002). There was no significant difference in blood loss and length of stay between two groups.Conclusion: The preferred ureteroneocystostomy technique used was open surgery, with the most common etiology of the patients underwent the procedures were vesicoureteral reflux and ectopic ureter. In addition, the open surgery approach also leads to a shorter procedure duration than laparoscopy.

Results of a previously unreported extravesical ureteroneocystostomy technique without ureteral stenting in 500 consecutive kidney transplant recipients.

Urologic complications can still occur following kidney transplantation, sometimes requiring multiple radiological and/or surgical procedures to fully correct the problem. Previously proposed extravesical ureteral reimplantation techniques still carry non-negligible risks of the patient developing urologic complications. About 10 years ago, a new set of modifications to the Lich-Gregoir technique was developed at our center, with the goal of further minimizing the occurrence of urologic complications, and without the need for initial ureteral stent placement. It was believed that an improvement in the surgical technique to minimize the risk of developing urologic complications was possible without the need for stent placement at the time of transplant. In this report, we describe the advantages of this technique (i.e., mobilized bladder, longer spatulation of the ureter, inclusion of bladder mucosa with detrusor muscle layer in the ureteral anastomosis, and use of a right angle clamp in the ureteral orifice to ensure that it does not become stenosed). We also retrospectively report our experience in using this technique among 500 consecutive (prospectively followed) kidney transplant recipients transplanted at our center since 2014. During the first 12mo post-transplant, only 1.4%(7/500) of patients developed a urologic complication; additionally, only 1.0%(5/500) required surgical repair of their original ureteroneocystostomy. Five patients(1.0%) developed a urinary leak, with 3/5 having distal ureteral necrosis, and 1/5 subsequently developing a ureteral stricture. Two other patients developed ureteral stenosis, one due to stricture and one due to ureteral stones. These overall results are excellent when compared with other reports in the literature, especially those in which routine stenting was performed. In summary, we believe that the advantages in using this modified extravesical ureteroneocystostomy technique clearly help in lowering the early post-transplant risk of developing urologic complications. Importantly, these results were achieved without the need for ureteral stent placement at the time of transplant.

Surgical technique for right ureteral DIE resection and ureteroneocystostomy by the Leadbetter-Politano technique: a step by step description. DIE, deep infiltrative endometriosis.

Surgical technique for right ureteral DIE resection and ureteroneocystostomy by the Leadbetter-Politano technique: a step by step description. DIE, deep infiltrative endometriosis.

A Comparison between Two Kidney Transplant Ureteroneocystostomy Techniques: Full-Thickness Single Layer Anastomosis and Lich-Gregoir

Urinary complications such as urine leak, stricture, ureteric obstruction and vesicoureteral reflux are the most common technical adverse events following A variety of urinary tract reconstructive methods have been proposed and compared to find an ideal method with minimum urinary complications. Today, ureteroneocystostomy is the most common urinary tract reconstructive method utilized in kidney transplantation. The main aim of the present study was to compare urologic complications following the use of FTSL and LG techniques in kidney transplant ureteroneocystostomy in a clinical trial study.

Utilizing an Umbilical Ligament for Complex Ureteroneocystostomy

To overcome the tension of anastomosis between ureter and bladder for complex ureteroneocystostomy in children, we describe a novel technique utilizing an ipsilateral umbilical ligament (occluded umbilical artery) to fix the bladder. From July 1991 to December 2013, 18 patients (13 girls, 5 boys) underwent our technique for complex ureteroneocystostomy. Median age at surgery was 61 months. The main indications for surgery were ectopic ureter in 9 patients, primary obstructive megaureter in 3, and persistent vesicoureteral reflux after surgery in 2. The ipsilateral umbilical ligament was ligated. A new hiatus was created craniolateral to the original hiatus. The submucosal tunnel was created trans-trigonally. The umbilical ligament was sutured to the whole bladder muscle at the hiatus. Ureteroneocystostomy was then performed. Mean duration of postoperative follow-up was 62.6 months. Seventeen patients underwent unilateral ureteroneocystostomy with our technique. One patient underwent bilateral ureteroneocystostomy with our technique on one side. Vesicoureteral reflux was not shown in 92.3% of patients and no signs of obstruction developed in any patients. No complications were encountered with our procedure. Utilizing an umbilical ligament for ureteroneocystostomy to fix the bladder is an excellent option when the distal ureter creates tension in uretero-bladder anastomosis. This method seems to be applicable in many cases of complex ureteroneocystostomy in children.

Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique for Ureteroneocystostomy

Aim: Various ureteroneocystostomy techniques for kidney transplant have been described with Lich-Gregoir (LG) being widely employed. However, even with multiple modifications on this technique, urine leakage and ureteric stenosis remain as most common complications. This study aims to evaluate urological complications by using our modified LG technique after kidney transplant. Method: From 26th January 2010 to 30th May 2014, 206 consecutive kidney transplants were performed at our institute. 124 were deceased-donor and 69 were live-donor kidney transplants; 13 patients received a small tumour excised kidney graft. All transplants except one were done by conventional open surgery. The modification involves an additional stitch placed at proximal part of bladder muscular incision with peri ureteric tissue at the entrance of ureter to bladder. Urological complications were defined as urine leakage or ureteral stricture. The patients were followed-up from 12 to 64 months. Results: There was no urine leakage in this cohort. One case of ipsilateral dual-kidney transplant developed distal ureteral stricture secondary to a lymphocele that was treated by laparoscopic fenestration. Subsequently, surgical reconstruction of urinary tract was required and success. Seven cases had mild to moderate hydronephrosis identified on CDU; 4 were due to a lymphocele; 3 were secondary to urinary tract stones. Four patients had renal pelvis prominence on CDU, which was spontaneously resolved with satisfactory renal function. Conclusion: From this study, it is demonstrated that urine leakage can be prevented and ureteric stricture may be minimised by using this modified LG technique. The ureter was always shortened in an adequate length and a ureteric stent was inserted. This modification is simple and reproducible by placing additional two stitches, which secure the potential gap at the entrance of ureter to the bladder.

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates.

To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients). In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.

Combined Use of Intravesicular Ureteroneocystostomy Techniques to Correct Ureteral Ectopia in a Male Cat

A 2 yr old castrated male Himalayan presented for evaluation and treatment of persistent urinary incontinence that had been present since birth. Ultrasonographic evaluation of the urinary tract revealed suspected bilateral, extramural, ureteral ectopia that was confirmed at the time of surgical exploration. Marked left hydroureter and a normal right ureter were found entering the urethra ∼ 2 cm caudal to the bladder neck. An intravesicular mucosal apposition (modified Leadbetter-Politano) and "drop-in" ureteroneocystostomy techniques were used for reimplantation of the left and right ureter, respectively. Postoperatively, the cat gained urinary continence and remained continent and clinically normal 6 mo following surgery.

Modified Extravesical Ureteroneocystostomy in Cadaveric Kidney Transplantation with Completely Duplicated Ureters: A Case Report

Completely duplicated ureters are not commonly used in renal transplantation due to increased risk of postoperative complications, such as urinary tract infections, stricture, reflux and urinary leakage. Although recent results have indicated that the occurrence of these complications is similar to that of a single ureter, few reports exist of renal transplantations of kidneys with ureteral duplication. Here, we report successful renal transplantation of a cadaveric kidney with completely duplicated ureters to a 52-year-old final stage renal disease patient who had been on dialysis for 19 years. A modified extravesical ureteroneocystostomy technique was employed, in which distal ureteric ends were spatulated and their medial edges were approximated. Double-j stent catheters were inserted during the ureteroneocystostomy and removed after 21 days when progressive serum creatine levels had decreased. During 6 months following the operation so far, no urinary tract infections, hydronephrosis, pyelonephritis, stricture, or reflux was reported. We conclude that modified extravesical ureteroneocystostomy, a newly described technique is suitable for the transplantation of a cadaveric kidney with complete ureteral duplication.

Comparative study of one-stitch versus Lich-Gregoir ureterovesical implantation for kidney transplants

To compare the outcomes of standard Lich-Gregoir technique and a modified one-stitch technique of ureteroneocystostomy in renal transplantation. Data from 645 transplant recipients by two different ureteroneocystostomy techniques were retrospectively reviewed at the first Affiliated Hospital, Medical College of Xi'an Jiaotong University, between January 2002 and December 2007. There were 418 recipients in the Lich-Gregoir group and 227 in new one-stitch group. The overall ureteral complication rate for new one-stitch technique was 19.8 % (n = 45) as opposed to 15.79 % (n = 66) for the Lich-Gregoir technique. No significantly different rate of ureteral complications occurred in two groups (P > 0.05). In comparison, there was a higher proportion of hematuria at the limit of statistical significance in new one-stitch group (P < 0.05). Average operative time for the modified one-stitch and Lich-Gregoir techniques was 8.8 ± 1.4 and 21.9 ± 6.1 min, respectively (P < 0.05). Urinary tract infections, delayed graft function and rejection rates were not significantly different between the two groups (P > 0.05). Although the modified one-stitch technique may predispose patients to higher rates of hematuria, it has no significant difference in ureteral complications compared with the Lich-Gregoir group. Based on this large series and data analyses, we believe that this new technique will become one of our multiple choices in our setting.

Influence of Ureteric Anastomosis Technique on Urological Complications After Kidney Transplantation

The best technique for anastomosis of the donor ureter remains unresolved and an individual surgeon's preferred technique is likely to be based on training background. This retrospective analysis compares three ureteroneocystostomy techniques in 204 consecutive transplants with an overall ureteric complication rate of 7.3%. Ureteric complications after kidney transplantation present early, are more common when using deceased donor kidneys, and, require complex reconstructive surgery to resolve. Three significant and related findings have been demonstrated with a common theme related to the length of the transplanted ureter, and not, the debate over extravesical versus intravesical techniques.

Long-term Result in Ureteroneocystostomy for Complete Duplicated Ureters in Renal Transplantation

Duplicated ureters are the most common congenital malformation of the upper urinary tract, but there are few reports on the transplantation of kidneys with duplicated ureters. We introduce different techniques for the ureteroneocystostomy of double ureters and long-term results. We specifically detail the experience of two patients with duplicated ureters at Bong Seng Memorial Hospital from March 1995 to May 2012. In our first case, the top technique of spatulating and suturing duplicated ureters was applied with the bottom technique for double ureteroneocystostomy. The operation time was 4 hours and 45 minutes, while the ureteroneocystostomy took 32 minutes. In the second case a double-armed 4.0 Vicryl suture was placed on each tip of the ureter and both needles passed from the inside out through the bladder wall. The ureters were pulled into the bladder and the suture was tied on the serosa of the bladder. The operation time was 3 hours and 50 minutes, while the ureteroneocystostomy took 15 minutes. Neither urological complications nor urinary tract infections were observed in the follow-up period and no double-J stent was needed. We therefore conclude that these two techniques are available procedures for handling duplicated ureters, with the technique applied in the second case particularly time-effective.

Laparoscopic Ureteroneocystostomy: Modification of Current Techniques

PurposeTo review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions.Materials and MethodsWe conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side.ResultsThe laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period.ConclusionsThe technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.

The Long Term Follow-Up Results of the Direct Nipple Ureteroneocystostomy Technique: A Prospective Study

Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple ureteroneocystostomy. The mean age was 43 years and 3 patients had bilateral disease. In five units the ureters had been ligated during gynecological surgery, 11 renal units were obstructive and three units were reflexive megaureters. The ureters were spatulated for about 2 cm and folded back. Nipples 2 to 2.5 cm long were prepared. In two cases the ureters were thin-walled (2 mm or less) and they were not spatulated but folded back onto themselves. In one case the ureter could not be everted since it had a thick and fibrotic wall. The distal 2 to 2.5 cm segment of this ureter was directly inserted in to the bladder. Postoperative follow-up was at 3 month intervals for the first year at 6 month intervals for 2 - 3 years and yearly thereafter. At the time of follow-up serum creatinine, urine culture, ultrasound, intravenous urography, voiding cystoureterography, nuclear renal scintigraphy and cystometric evaluations were performed. The functions of 11 and 15 renal units were evaluated scintigraphically and stereologically, respectively, in the both preoperative and postoperative first year follow-up. The Wilcoxon Signed Ranks test was used for statistical evaluation and p Results: Mean follow-up was 49 months. Three renal units had Grade III reflux (two of them during voiding) and one unit had Grade IV reflux. At follow-up this patient developed in the ureteral stricture. No patients had urinary tract infection, pyelonephritis or ureteral stricture follow-up period. Between the preoperative and postoperative first year, there was an increase in postoperative split renal function based on renal scintigraphy but this difference was not statistically significant. The stereologically calculated decrease in pelvicaliceal dilatation was statistically significant. Conclusion: Ease of application and no need to taper or plicate the ureter or prepare a submucosal tunnel may be the reasons to consider the direct nipple ureteroneocystostomy technique for megaureters of different etiologies.

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

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.

Kidney transplant ureteroneocystostomy: comparison of full‐thickness vs. Lich–Gregoir techniques

Despite a variety of urinary tract reconstructive techniques, urinary complications are the most frequent technical adverse event following kidney transplantation. We examined outcomes of two ureteroneocystostomy techniques, the full-thickness (FT) technique and the Lich-Gregoir (LG) technique in 634 consecutive kidney-alone transplants (327 FT and 307 LG) between December 2006 and December 2010. Urological complications at one yr post-transplantation occurred in 27 cases (4.3%) including 16 ureteral strictures (2.5%), four ureteral obstructions (0.6%) owing to donor-derived stones or intrinsic hematoma, and seven urine leaks (1.1%). Compared with LG, the FT technique was associated with similar proportions of ureteral complications overall (3.9% vs. 4.6%, p = 0.70), ureteral strictures (3.7% vs. 1.3%, p = 0.08), urinary stones/hematoma (1.0% vs. 0.3%, p = 0.36), and overall urinary leaks (1.6% vs. 0.6%, p = 0.22); however, the FT technique was associated with somewhat fewer urine leaks at the ureterovesical junction (0% vs. 1.3%, p = 0.05). There were no differences between the two groups in terms of length of stay, delayed graft function, urinary tract infection with the first post-transplant year, estimated glomerular filtration rate, and overall graft and patient survival. The FT technique of ureteroneocystostomy is technically simple to perform and has a similar incidence of urinary complications compared with the LG technique.