Ureteral length in live donor kidney transplantation; Does size matter?

Abstract

SummaryThe aim of this study was to evaluate the role of ureteral length on urological complications. Data were retrospective collected from the INEX-trial database, a RCT to compare the intravesical to the extravesical ureteroneocystostomy. Ureteral length was measured in 198 recipients and used to divide recipients into three categories based on interquartile ranges: short (≤8.5 cm), medium (8.6-10.9 cm) and long ureters (≥11 cm). Urological complications were defined as the number of percutaneous nephrostomy placements (PCN). Fifty recipients fell into the short, 98 into the medium and 50 recipients into the long ureter category. Median follow-up was 26 (range 2-45) months. There was no significant difference in number of PCN placements between the categories. There were 9 (18%) PCN placements in the short ureter category, 21 (20%) in medium ureter category and 10 (21%) in the long ureter category, P = 0.886. Risk factor analysis for gender, arterial multiplicity and type of ureteroneocystostomy showed no differences in PCN placements between the three ureteral length categories. We conclude that ureteral length alone does not seem to influence the number of urological complications.

An Update on Early Urological Complications in Kidney Transplantation: A National Cohort Study

“…In contradiction to many previous studies stressing the importance of preservation of the peri-ureteric connective tissue to prevent ischemia of the distal ureter [4,5,12,13], our sub-study did not reveal a direct association between peri-ureteric tissue preservation and postoperative MUCs in living-donor KTX. Likewise, Ooms and colleagues hypothesized that a shorter length of the ureter would be accompanied by better vascularization, but found no influence of ureteral length on MUCs [21]. In summary, visual judgement of the amount of peri-ureteric tissue preservation appears to be a subjective and unreliable way to assess vascularization of the distal ureter.…”

Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green

“…These observations can be explained by considering ureteral vascularization. Ureteric blood supply depends on branches of the renal artery [ 36 ], particularly the lower polar artery branches that traverse in periureteric tissue [ 4 ]. In consequence, extensive periureteric dissection should be avoided to preserve the arterial blood supply during harvesting and bench dissection.…”

Intraoperative assessment of ureter perfusion after revascularization of transplanted kidneys using intravenous indocyanine green fluorescence imaging

“…We believe that gentle manipulation of the ureter and adequate preservation of periureteral tissue, while properly maintaining the length of the ureter without tension, are of key importance. A ureter with ischemic appearance after reperfusion should be resected until a good area of perfusion is achieved (22)(23)(24)(25).…”