URETERIC IMPLANTATION IN RENAL TRANSPLANTATION A Technical Modification

Kenefick, J. S.; Fernando, O. N.; Hopewell, J. P.; Moorheàd, J. F.

doi:10.1111/j.1464-410x.1972.tb10084.x

British Journal of Urology

1972

DOI: 10.1111/j.1464-410x.1972.tb10084.x

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URETERIC IMPLANTATION IN RENAL TRANSPLANTATION A Technical Modification

J. S. Kenefick¹,

O. N. Fernando²,

J. P. Hopewell³

et al.

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1974

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Cited by 3 publications

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“…Fistulas and stenosis of the ureter often lead to loss of the graft or even to death of the patient. To avoid fistulas, most surgical teams now recommend the ureterovesical anastomosis, in which a submucosal tunnel is created in the bladder as described by Po!itano and Leadbetter [1], or one of the variants [2][3][4]. However, even with this technique the frequency of fistulas ranges from 1 to 25% [5][6][7][8][9][10][11][12][13].…”

mentioning

confidence: 99%

Ureterocystostomy in renal transplantation: Comparison of endo‐ and extravesical anastomoses

et al. 1977

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Among 241 renal transplants with implantation of the ureter into the urinary bladder, the endovesical technique of Politano and Leadbetter (PL) was used in 108 cases and the extravesical technique of Grégoir and Lieh (GrL) was used in 133. Urinary fistulas occurred in 10 patients (9.3%) with the PL technique and in only 1 patient (0.8%) with the GrL technique. The difference was highly significant (p<0.01). Stenosis of the ureter developed in 3 patients (2.8%) following the PL technique and in 9 patients (6.8%) after the GrL technique, an insignificant difference (p>0.10). None of the complications resulted in death or failure of transplantation. It is concluded that the extravesical technique of Grégoir and Lich is the best method of avoiding urinary leakage, which is the most dangerous urologic complication of kidney transplantation.

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confidence: 99%

Ureterocystostomy in renal transplantation: Comparison of endo‐ and extravesical anastomoses

et al. 1977

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“…Extravesical ureteroneocystostomy has shown to be the preferable method for urinary tract reconstruc tion, providing satisfactory results in our hands. The technique of ureteroneocystostomy at the dome of the bladder, performed since Among the many postoperative complications which may develop after renal transplantation, the urological ones are potentially serious and dreaded (2,4,8,17,50). The preexisting uraemic state of a dialyzed patient often leads to a debilitated physical condition (16,19,29) with impaired healing and increased risk of infection, these being poten tiated by immunosuppression.…”

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confidence: 99%

Urological Complications in Renal Transplantation

Dreikorn¹,

Röhl²

1975

Eur Urol

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The Surgery and Problems of the Ureter in Human Renal Transplantation

Bewick

Collins

Saxton

et al. 1974

British Journal of Urology

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There is now extensive experimental and clinical experience of renal allotransplantation, but there is still an appreciable incidence of complications referable to disorders of urinary drainage.The main reported series since 1966 (Table I) shows that the incidence of such urological problems is between 10 and 20% with a significant mortality. This paper reviews our management of 200 consecutive transplants and describes details of techniques used and developed in the light of our experiences, with particular reference to the problems which arise in relation to the ureter. Primary Surgical TechniquesPrimary urinary drainage was achieved in I96 cases using the technique of uretero-cystostomy. A sub-mucous tunnel was created after the technique of Politano and Leadbetter (1958) and the ureter anastomosed to the mucosa of the bladder after the nipple technique of Paquin (1959) and Starzl et al. (1964).Only a few points need mentioning about these techniques. Paccione (1965) pointed out that the normal ureter, when divided, immediately starts to swell owing to oedema of the adventitia. In the case of the renal allograft this swelling does not start until the kidney is re-vascularised, and the ureter will swell, not only because it has been divided, but also because there is a reactive hyperaemia due to the ischaemia and, possibly, some mild early allograft reaction. Thus the incision through the bladder muscle layer and the sub-mucosal tunnel must be large. We have not attempted to place the ureteric orifice in any particular site in the bladder. We believe that a site convenient for the surgeon is more important than a correct anatomical situation. We have been careful not to disturb the patient's own ureteric orifices. The ureteric epithelium and the vesical mucosa are united by multiple interrupted 4/0 chromic catgut sutures. The ureteric vasculature is not formally ligated, but care is taken to ensure that the interrupted sutures occlude the vessel at the end of the spatulated ureter.At no time have we found the production of a sub-mucous tunnel difficult and have not found it necessary to use the technique described by Kenefick et al. (1972). Only occasionally does haemorrhage within the tunnel occur and we have found that this usually subsides satisfactorily if a little pressure is applied before the ureter is passed along it. Only 2 patients have presented early after transplantation with ureteric obstruction which could possibly have been due to the presence of a sub-mucous tunnel haematoma. A ureteric splint was used in only 3 cases where there was some technical difficulty in performing the ureter-to-mucosa anastomosis. These splints were removed uneventfully on the first postoperative day.The anterior cystostomy is closed with 2 layers of continuous 2/0 chromic catgut and an outer layer of interrupted catgut. After closure, the intramuscular part of the tunnel is again inspected from the external aspect of the bladder and ascertained to be adequate. Initially, drains to the retropubic space and/or the ret...

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URETERIC IMPLANTATION IN RENAL TRANSPLANTATION A Technical Modification

Cited by 3 publications

References 8 publications

Ureterocystostomy in renal transplantation: Comparison of endo‐ and extravesical anastomoses

Ureterocystostomy in renal transplantation: Comparison of endo‐ and extravesical anastomoses

Urological Complications in Renal Transplantation

The Surgery and Problems of the Ureter in Human Renal Transplantation

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