Ureteroneocystostomy versus Ureteropyelostomy: A Comparison in the Same Renal Allograft Series

Donohue, John P.; Hostetter, Michael; Glover, John L.; Madura, James A.

doi:10.1016/s0022-5347(17)66985-4

Cited by 21 publications

(3 citation statements)

References 10 publications

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“…Donohue et al [6] reported a case series of 132 renal transplant patients that underwent UNC (n ¼ 88) or PU (n ¼ 44). Outcome measures were urinary complications.…”

Section: Discussionmentioning

confidence: 99%

Urinary reconstruction after kidney transplantation: Pyeloureterostomy versus ureteroneocystostomy

Norris

Ravi-Shankar

Klimach

2015

International Journal of Surgery

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A best evidence topic in transplant surgery was written according to a structured protocol. The question addressed was: In adults undergoing renal transplantation, does pyeloureterostomy, as compared to ureteroneocystostomy, improve clinical outcomes? A total of 235 articles were identified using the search protocol described, of which six represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. These included one prospective cohort study, three retrospective cohort studies and two case series. The largest of the five cohort studies demonstrated significantly reduced levels of complications with pyeloureterostomy as compared to ureteroneocystostomy. The consensus from the remaining trials was that pyeloureterostomy is a safe but underused technique. However, the majority of the evidence pertaining to pyeloureterostomy and ureteroneocystostomy was archaic, with four of the six dating from pre-1990. Furthermore, the most recent articles (reported in 2010 and 2013) provide only level three and four evidence respectively, and contain important flaws with regard to patient-cohort allocation inherent to the study design. For these reasons we are cautious in recommending pyeloureterostomy over ureteroneocystostomy with the current evidence base, but would like to emphasise that pyeloureterostomy remains a safe surgical option which should form part of the modern transplant surgeon's reconstructive repertoire, particularly when managing patients in which multiple complications are anticipated, or when there is fear of ureteral vascular compromise, such as with cadaveric kidneys. We call for larger scale prospective trials to aid clarification of the roles of pyeloureterostomy and ureteroneocystostomy in renal transplant surgery and to enrich this prescient field with much needed 21st century evidence.

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“…Donohue et al [6] reported a case series of 132 renal transplant patients that underwent UNC (n ¼ 88) or PU (n ¼ 44). Outcome measures were urinary complications.…”

Section: Discussionmentioning

confidence: 99%

Urinary reconstruction after kidney transplantation: Pyeloureterostomy versus ureteroneocystostomy

Norris

Ravi-Shankar

Klimach

2015

International Journal of Surgery

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“…The ureteroneocystostomy should be protected by the retention of a urethrovesical catheter for more than 2 days in diabetic patients or patients presenting with high-level postoperative diuresis [5].…”

Section: Discussionmentioning

confidence: 99%

A simplified technique for ureteroneocystostomy in renal transplantation

Caparrós

Regalado²,

Sánchez-Martín³

et al. 1996

World J Urol

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From October 1988 to December 1993, 148 kidney transplants were carried out at our institution. An extravesical ureteral reimplantation technique resulting in a submucosal tunnel in the bladder wall was performed on 101 of the patients. For this technique, two small incisions are made at the outer part of the bladder wall until the mucosa is seen, then a submucosal tunnel is dissected between them and the graft's ureter is introduced and advanced in it (Alférez-Barry). Afterward the bladder mucosa is opened at the distal incision and the ureter is introduced into the bladder and fixed by a single direct anchorage stich (Taguchi). The minimal patients' follow-up is 18 months. Complications deriving from ureter reimplantation with this technique were present in 12.8% of the patients and included 4 cases of stenosis (3.9%), 4 cases of urinary fistula (3.9%), and 5 cases of hematuria (4.9%). We conclude that submucosal tunnelled ureteroneocystostomy with direct anchorage is a technique that simplifies kidney transplant surgery with good results. Ureteral direct anchorage can be used in any kind of ureteral anastomosis.

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“…Ureteroneocystostomy has become the pre ferred method of urinary tract reconstruction because of the relatively low incidence of postoperative fistula for mation and ureter obstruction [4][5][6][7][8], Although primary pyeloureterostomy proved to be a safe alternative [9,10], this technic is mainly used for secondary reconstruction of the urinary collecting system after renal transplantation [11]. Herein we report our results with secondary pyelo ureterostomy after necrosis of the graft ureter.…”

Section: Introductionmentioning

confidence: 99%

Secondary Pyeloureterostomy after Ureter Necrosis in Renal Transplant Recipients

1992

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After kidney transplantation, urological complications account for significant morbidity necessitating reoperation in a substantial number of patients. In cases with urinary tract necrosis after renal transplantation secondary pyeloureterostomy represents an accepted method for urinary tract reconstruction. In our institution 2% of all kidney grafts required secondary pyeloureterostomy. In all cases the recipient’s own ureter was investigated before reoperation by retrograde pyeloureterography. Pyeloureterostomy was performed with a standard technic, the recipients own kidney being removed in all but 5 patients. All 25 patients had normal kidney function immediately after secondary pyeloureterostomy. Urological complications occurred in 7 patients (anastomotic leakages in 4, stenosis in 3); 5 out of 7 complications were managed conservatively (nephrostomy, transureteral stenting). Two patients needed reexploration for reanastomosis. Our results confirm the simple and safe technic of pyeloureterostomy for urinary reconstruction in patients with ureter necrosis after renal transplantation.

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Ureteroneocystostomy versus Ureteropyelostomy: A Comparison in the Same Renal Allograft Series

Cited by 21 publications

References 10 publications

Urinary reconstruction after kidney transplantation: Pyeloureterostomy versus ureteroneocystostomy

Urinary reconstruction after kidney transplantation: Pyeloureterostomy versus ureteroneocystostomy

A simplified technique for ureteroneocystostomy in renal transplantation

Secondary Pyeloureterostomy after Ureter Necrosis in Renal Transplant Recipients

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