Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis

Abstract

SummaryNo consensus exists about which ureterovesical anastomosis technique to use for kidney transplantation. The aim of this systematic review was to compare the existing techniques in relation to the risk of urological complications. All studies that compared ureterovesical anastomotic techniques in kidney transplantation were included. Study endpoints were urinary leakage, ureteral stricture, vesicoureteral reflux and hematuria. Subanalyses of stented and nonstented techniques were performed. Two randomized clinical trials and 24 observational studies were included. Meta-analyses were performed on the Lich-Gregoir (LG) versus Politano-Leadbetter (PL) techniques and LG versus U-stitch (U) techniques. Compared with the PL technique, the LG technique had a significantly lower prevalence of urinary leakage (risk ratio (RR): 0.47, 95% confidence interval (CI): 0.30 to 0.75) and a significantly lower prevalence of hematuria when compared with both PL and U techniques (RR: 0.28, 95% CI: 0.16 to 0.49 and RR: 0.23, 95% CI: 0.11 to 0.50, respectively), regardless of ureteral stenting. There was no difference in the prevalence of ureteral strictures or vesicoureteral reflux between the various techniques. Of the three most frequently used ureterovesical anastomotic techniques, the LG technique results in fewer urological complications than the PL and U techniques.

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

“…Extravesical ureteroneocystostomy has been in favour in comparison with intravesical ureteroneocystotomy in recent systematic reviews [5,6]. Also, systematic review and meta-analysis have supported the placement of ureteric stent for ureteroneocystostomy.…”

“…In the extravesical approach, Lich-Gregoir (LG) technique has become widely employed due to its advantages of use of a shorter ureter, mimimal bladder dissection, and less complications. Nevertheless, LG technique still has a risk of urine leakage in 1.6% and ureteric stricture in 1.9% [5].…”

Multiple Renal Arteries in Live Donor Renal Transplantation; Impact on Graft Function and Outcome: A Prospective Cohort Study

“…The donor artery to IEA anastomosis was done in an end-to-end fashion with 7/0 interrupted polypropylene suture. The ureteric anastomosis was done to the recipient bladder to form a neoureterocystostomy in the standard Lich-Gregoir fashion over a 5 Fr ureteric stent [7]. All transplants received standardized immunosuppression comprising of basiliximab induction and prednisolone, tacrolimus and mycophenolate triple therapy posttransplant.…”

The ideal timing of ureteric stent removal in transplantation patients

“…Dear Sirs, With great interest, we read the paper by Alberts et al [1], in which the authors report the results of their systematic review of urological complications following various ureterovesical anastomotic techniques. The authors included a subanalysis of the effect of stenting on outcomes from various ureterovesical anastomotic techniques.…”