Parallel incision, unstented extravesical ureteroneocystostomy: followup of 203 kidney transplants

A parallel incision, unstented extravesical ureteroneocystostomy was used in 203 human kidney transplants. The reoperation rate was 1 per cent. Extravasation of urine occurred in 3 patients, 1 of whom required surgical repair. One patient required transurethral fulguration of a ureteral bleeder. Two patients had grade 1 reflux and none required repair. No patient had ureteral obstruction at the anastomosis. This simple technique is useful because ureteral length and bladder dissection are minimal, and no separate cystotomy is required. The adequacy of the submucosal tunnel is judged when the ureter is passed through it.     

Experience with parallel incision extravesical ureteroneocystostomy in renal transplantation

A total of 43 consecutive renal transplant patients underwent extravesical ureteroneocystostomy via a parallel incision. The only urological complication (ureteral obstruction from a blood clot) did not appear to be related to this recently described technique. There were no instances of urinary leakage, extrinsic ureteral obstruction or reflux. This simplified technique of ureteroneocystostomy seems well suited to the special challenges presented by renal transplant patients.     

Unstented extravesical ureteroneocystostomy in kidney transplantation

An alternate procedure for extravesical ureteroneocystostomy is described. The procedure is useful because of the lateral placement of the ureter, limited cystotomy and limited exposure of the bladder. There were no ureteral complications in 11 patients undergoing kidney transplantation with this technique of urinary tract reconstruction.     

Modified extravesical ureteral reimplantation technique for kidney transplants

Purpose We describe a modification and evaluate a technique of extravesical ureteral reimplantation for kidney transplant. Materials and methods We reviewed the records of 120 kidney transplant recipients who underwent ureteral reimplantation via a modified extravesical technique. Follow-up evaluation included renal ultrasonography. Because reflux is not routinely assessed in transplant cases, only symptomatic reflux was considered a complication and accessed with voiding cystourethrography (VCUG). The urological complications evaluated included urinary fistula, ureteral stenosis and symptomatic vesicoureteral reflux. Results The modified extravesical technique produced a successful result in 93.4% of patients with no symptomatic reflux or anastomotic obstruction. Anastomotic complications included stenosis in four patients, prolonged leakage and fistula in three patients, and symptomatic vesicoureteral reflux in one patient. Other urologic complications included complicated hematuria in three patients, postoperative urosepsis in one patient, and ureteral stenosis caused by extrinsic compression in three patients due to lymphocele (two patients) and by adhesions (one patient). Conclusions The modified extravesical ureteral reimplantation is a reliable procedure with predictable results comparable to those of more-traditional techniques and proved to be efficient without increasing the incidence of urological or anastomotic complications. This modified technique offers two advantages; removal of the ureteral stent with the urethral catheter without the need for a postoperative cystoscopy and facilitation of postoperative endoscopic maneuvers if needed.     

Transurethral incision of ureteroneocystostomy strictures in kidney transplant recipients

OBJECTIVES: To report the treatment of patients who presented with vesico-ureteric stricture after kidney transplantation, using a minimally invasive endourological approach. PATIENTS AND METHODS: Patients (10 men and four women, mean age 34 years, range 22-55) were assessed at presentation by serum creatinine level, ultrasonography and intravenous pyelography when the serum creatinine level was < 200 micromol/L. When there was hydronephrosis of the allograft a percutaneous antegrade pyelogram was taken, followed by inserting a nephrostomy. After decompression a stent nephrostomy was passed into the bladder and the strictures at the vesico-ureteric junction incised along the stent during cystoscopy. RESULTS: All 14 patients were treated endourologically by an endoscopic incision through the bladder; 13 fared well and one died from sepsis and transplantation problems. The mean follow-up was 8 months. CONCLUSIONS: Simple incision of the stricture via cystoscopy was safe and effective, and succeeded in most patients. The endourological management of ureteric lesions is feasible and is currently our first-line management of ureteric complications after kidney transplantation.     

Complications of kidney transplants]

Increasingly more publications are reported on reassuring results after kidney transplantation. After some initial difficulties promising results were achieved on three patients who now live with a transplanted kidney. The importance of improving diagnostic possibilities and the reduction of damages caused by immunosuppressive drugs is stressed and the possibility of altering if necessary the combination of drugs is suggested.     

Evaluation of extravesical and Leadbetter-Politano ureteroneocystostomy in renal transplantation

In a series of 650 renal transplantations performed over a 4- year period, the results were evaluated of 125 Leadbetter-Politano and 125 extravesical ureteroneocystostomies. The Leadbetter-Politano technique had a complication rate of 4%, with 3.2% of these patients having a vesical leak. Extravesical ureteroneocystostomy also had a 4% complication rate but only 1.6% of these patients had a vesical leak. Although there was no statistical difference between the two groups with regard to complications, we feel that extravesical ureteroneocystostomy is a quick and simple procedure and well suited to the special challenge presented by renal transplant recipients.     

Modified extravesical ureteroneocystostomy for completely duplicated ureters in renal transplantation

INTRODUCTION: Completely duplicated ureters are the most common congenital malformation of the upper urinary tract. However, there are very few reports on transplantation using kidneys with double ureters, and the technique of ureterocystoneostomy for completely duplicated ureters has not yet been established. PATIENTS AND METHODS: We treated 3 patients with completely duplicated ureters at our institutions from January 1998 to October 2005. We modified the extravesical technique for treating these 3 cases and evaluated the 52-month follow-up period for possible urological complications. RESULTS: Neither urological complications nor urinary tract infections occurred in the follow-up period after using our new technique. CONCLUSION: We conclude that this technique is an appropriate procedure for the transplantation of kidneys with completely duplicated ureters.     

Urologic complications of extravesical ureteroneocystostomy in renal transplantation from living related donors

INTRODUCTION: Reconstruction of the urinary system during renal transplantation is usually performed with antirefluxive ureteroneocystostomy techniques and extravesical methods are usually preferred. MATERIAL AND METHODS: Between 1983 and 1997, 241 renal transplantations from living donors were performed at our institution. A variation of the Lich-Gregoir technique was used as the ureteroneocystostomy method in all cases. RESULTS: A total of 12 (4.9%) urologic complications were observed. Urinary fistula developed in 5 (2%) cases and were explored surgically during the early postoperative period. Postoperative vesicoureteral reflux (VUR) to the transplanted kidney was identified in 7 (2.9%) cases. Either endoscopic or surgical interventions resolved VUR in 4 cases while the other 3 did not need further treatment. No ureteral stenosis was observed. There was no loss of graft due to urologic complications. CONCLUSIONS: Urologic complications after renal transplantation are reported to be about 7% and ischemia is blamed as the major contributing factor. Preparation of the native ureter during donor nephrectomy and preservation of distal periureteral fatty tissue, anastomosis technique variations in vascular anatomy, rejections and medications are the major factors determining the ischemia.     

Complications following ureteroneocystostomy without antireflux technique in the adult (author's transl)]

65 adult patients subjected to direct uretero-vesical implantation without the use of a recognized antirefluxing technique were followed up to 9 years. Good results could be achieved in 90.8%, whereas failures were mainly due to radiation damage and malignant tumors. A postoperative stenosis was observed five times. Reflux was demonstrable in 7 cases, of which, however, only one was of pathologic significance.     

Thrombotic microangiopathy following pancreas after kidney transplants

Abstract:  Advances in immunosuppressive therapy and refinement in surgical techniques have allowed pancreas after kidney (PAK) transplantation to become a viable therapeutic option for patients with brittle type I diabetic recipients of a living donor or previous deceased kidney alone transplant. Although maintenance immunosuppressive therapy is not significantly changed after the addition of a pancreas, a temporary booster in immunosuppressive therapy and an increase in the dose of calcineurin inhibitor (CNI) are required after PAK transplantation. The latter has been implicated in the observed variable decline in kidney allograft function. We herein report two cases of kidney allograft dysfunction following PAK transplant due to biopsy-proven transplant, thrombotic microangiopathy (TMA). Whether PAK transplantation pre-disposes a subset of patients to the development of post-transplant TMA is not known. Diagnostic kidney biopsies should be considered in PAK transplant recipients with worsening kidney allograft function.