Low rate of developing urological complications following kidney transplantation in adults using a stentless ureteral anastomosis.

内容摘要

Severe urologic complications after kidney transplantation may require multiple radiological or surgical interventions. We previously reported outcomes using our modified extravesical ureteroneocystostomy technique which was designed to avoid routine stent placement at the time of transplant as well as to reduce post-operative urologic complications. Here, we reviewed 697 adult kidney-alone transplant recipients who were consecutively transplanted by a single surgeon at our center since 2014. During the first 12mo post-transplant, the observed percentage of patients who developed any urologic complication was 2.3% (16/697), and 2/16 patients developed a 2nd urologic complication (in total, 18 cases). The percentage developing a urinary leak or ureteral obstruction/stricture (including suspected cases) was 2.0% (14/697). Urinary leaks were observed in 9/18 cases, and ureteral obstructions/strictures were observed in 9/18 cases (including 3 UPJ obstructions). Additionally, ureteral necrosis was observed in 3/18 cases. Grade 4 vesicoureteral reflux was observed in 1 case, and one bladder rupture involving the ureteral anastomosis was observed (during an attempted removal of a large, suprapubic hematoma). Half of the 18 urologic cases required surgical intervention, while the rest of them were managed by interventional radiology. These outcomes compare favorably with published series, particularly those using routine ureteral stenting. Our extravesical ureteroneocystostomy technique appears to significantly reduce early post-transplant urological complications without the need for ureteral stent placement at the time of transplant. However, without having a direct control group, one cannot conclude that our extravesical ureteroneocystostomy approach without stenting is equivalent to optimally performed extravesical Lich-Gregoir ureteroneocystostomies with routine stenting.