Urological complications in renal transplantation: impact of a change of technique

Butterworth, P.C.; Horsburgh, T.; Veitch, P. S.; Bell, P. R. F.; Nicholson, M. L.

doi:10.1046/j.1464-410x.1997.00117.x

Cited by 97 publications

(54 citation statements)

References 5 publications

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“…The most common surgical repair was ureterovesical revision or reimplantation [10] , followed by an end-toend anastomosis between the graft and native ureter [5] , or an end-to-side anastomosis between the native ureter and the grafted renal pelvis [5] . Exceptionally, an end-toend anastomosis of the grafted ureter was performed for a very short stricture [2] .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years

Praz¹,

Leisinger²,

Pascual

et al. 2005

Urol Int

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Introduction: This study is a retrospective analysis of ureteral complications and their management from a monocenter series of 277 consecutive renal transplantations. Materials and Methods: From September 1979 to June 1999, 277 renal transplantations (cadaveric origin) were performed in 241 patients. The ureter from the kidney graft was inserted into the bladder according to the technique of extravesical implantation described by Lich-Gregoir and Campos-Freire. The study analyzed the time of occurrence and the type of complications observed. The different procedures to restore the transplanted urinary tract are presented. Results: Complications occurred in 43/277 renal transplantations (15.5%). Anastomotic urine leakage or ureteral stricture were the most frequent. The time to appearance of these complications was either short (<1 month) or late (>1 month) in a similar number of cases. Most cases were managed surgically: 33/43 cases (76.7%). The most frequent surgical repair was ureterovesical reimplantation (n = 13), followed by: ureteroureteral end-to-end anastomosis (native ureter–ureter transplant, n = 5); pyeloureteral anastomosis (native ureter–renal pelvis transplant, n = 5); simple revision of ureterovesical implantation (n = 4); resection and end-to-end anastomosis of the transplant ureter (n = 2); calico-vesicostomy (graft-bladder, n = 1); implantation according to Boari (n = 1); pyelovesicostomy with bipartition of bladder (n = 1), and pyeloileocystoplasty with detubularized ileal graft (n = 1). No deaths related to any of the urological complications were reported. However, 2 consecutive vesico-renal refluxes led to the loss of the kidney graft in the long-term. Conclusion: The rate of complications observed in this retrospective analysis is similar to the experience of other studies, ranging from 2 to 20%. If the classical extravesical ureteral bladder implantation is to remain an attractive technique due to its simplicity, the surgical team at the training center should be aware of all the means to prevent any ureteral complications, such as the choice of another implantation technique and/or insertion of a transient ureteral stent.

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Section: Resultsmentioning

confidence: 99%

“…However, its realization may be diffi cult and tedious in the presence of a short ureter or a small contracted or infl ammatory bladder [11] . Therefore, because of its simplicity and reliability, extra- Geneva n = 200 [13] Oxford n = 1,000 [10] Lausanne (current series) n = 277…”

Section: Discussionmentioning

confidence: 99%

Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years

Praz¹,

Leisinger²,

Pascual

et al. 2005

Urol Int

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“…LP technique requires one cystostomy to access the interior of the bladder and a second cystostomy to create a new ureteric orifice [13,14]. This technique is more laborious and has a higher incidence of haematuria [15][16][17]. Since then, various studies have reported their experience with different ureteroneocystostomy techniques and its associated urological complications.…”

Section: Discussionmentioning

confidence: 99%

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

He¹,

Ng²

2016

J Transplant Technol Res

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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 30 th 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.

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“…Las causas son de dos tipos: intrínsecas y secundarias a obstrucció n extrínseca. Las intrínsecas son especulativas y serían consecuencia de un exceso de disecció n del uré ter y de la vascularizació n perihiliar 19 y el rechazo renal 4 . La té cnica de ureteroneocistostomía se ha propuesto como factor importante en el desarrollo de estas complicaciones.…”

Section: Discusió Nunclassified

Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto

Abad

Mayans²,

Eizaguirre

et al. 2010

Actas Urol Esp

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Complicaciones quirú rgicas en el trasplante renal y su influencia en la supervivencia del injerto J. Barba Abad Ã , A. Rincó n Mayans, E. Tolosa Eizaguirre, L. Romero Vargas, D. Rosell Costa, J.E. Robles García, J.J. Zudaire Bergera, J.M. Beriá n Polo e I. Pascual Piédrola Departamento de Urología, Clínica Universidad de Navarra, Navarra, Españ a informació n del artí culo El estudio multivariado de la supervivencia del injerto de todo el grupo pone de manifiesto que la reintervenció n precoz es un factor de influencia independiente (odds ratio: 4,7; IC 95%: 2,2-10; po0,0001). La funció n diferida y la edad del donante mayor de 60 añ os son los otros factores influyentes.Conclusiones: Las complicaciones quirú rgicas influyen en la supervivencia del injerto. La necesidad de cirugía precoz es una variable con valor pronó stico independiente sobre supervivencia del injerto junto con la funció n diferida y la edad del donante.

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Urological complications in renal transplantation: impact of a change of technique

Cited by 97 publications

References 5 publications

Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years

Urological Complications in Renal Transplantation from Cadaveric Donor Grafts: A Retrospective Analysis of 20 Years

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

Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto

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