Evaluation of urologic complications in 30 cases of kidney transplantation with technique of proper exposure edge of bladder mucosa and U-stitch ureteroneocystostomy

Taguchi versus Lich-Grégoir Extravesical Ureteroneocystostomy in Kidney Transplantation: A Systematic Review

INTRODUCTION

Ureteric implantation of the transplanted ureter into native urinary bladder tissue in kidney transplantation recipients is essential for post-operative kidney function. We aimed to determine the effects of Taguchi versus Lich-Grégoir extravesical ureteroneocystostomy in kidney transplantation.

METHODS

We searched multiple databases (MEDLINE, Cochrane Library, and Web of Science), trial registries, and conference proceedings until March 2021. We included prospective studies comparing Taguchi and Lich-Grégoir ureteroneocystostomy in kidney transplantation. Two review authors independently screened the identified records, extracted data, evaluated the risk of bias using ROBINS-I, and assessed the certainty of evidence according to GRADE.

RESULTS

We identified 3 prospective studies with serious or critical risk of bias, leading to low-certainty evidence. We downgraded the risk of bias due to study limitations. Assessment and/or reporting of baseline imbalances, co-interventions, and confounding factors was insufficient in all included studies. The effect of Taguchi ureteroneocystostomy remains unclear.

CONCLUSION

Currently available evidence is not useful to determine the effect of Taguchi versus Lich-Grégoir ureteroneocystostomy in kidney transplantation. There is a need for methodologically better designed and executed studies, such as randomized controlled trials with long-term follow-up reporting baseline imbalances, co-interventions, and confounding factors.

Ureteral complications in renal transplantation: a comparison of the Lich-Gregoir versus the Taguchi technique

OBJECTIVE

Modifications of the Lich-Gregoir extravesical ureteroneocystostomy have become the standard technique for management of the ureter during renal transplantation. We performed a comparative outcome examination of the standard Lich-Gregoir technique and the Taguchi or "one-stitch" technique.

METHODS

We reviewed our experience at the University of Washington with the Taguchi (one-stitch, Minnesota) extravesical reimplant technique that involves tacking the distal ureter to the bladder mucosa with a single absorbable stitch.

RESULTS

During a 3.5-year period, 330 renal transplants were performed and in 73 cases a Taguchi ureteral anastomosis was employed rather than the Lich-Gregoir technique (238 cases). The overall complication rate for the Taguchi technique was 23% (n = 16) as opposed to 7.1% for the Lich-Gregoir technique. When comparing the Taguchi to the Lich-Gregoir technique, there was a significant increase in hematuria and ureteral complications (P = .002, .012). In a multivariate analysis, the Taguchi technique was a significant risk factor for both hematuria and ureteral complications.

CONCLUSIONS

In summary, our limited experience with Taguchi ureteroneocystostomy resulted in dramatically higher complication rates than the modified the Lich-Gregoir technique.

Risk factors for urinary complications after renal transplantation

Urinary complications are common following renal transplantation. The aim of this study is to evaluate the risk factors associated with renal transplant urinary complications. We collected data on 1698 consecutive renal transplants patients. The association of donor, transplant and recipient characteristics with urinary complications was assessed by univariable and multivariable Cox proportional hazards models, fitted to analyze time-to-event outcomes of urinary complications and graft failure. Urinary complications were observed in 105 (6.2%) recipients, with a 2.8% ureteral stricture rate, a 1.7% rate of leak and stricture, and a 1.6% rate of urine leaks. Seventy percent of these complications were definitively managed with a percutaneous intervention. Independent risk factors for a urinary complication included: male recipient, African American recipient, and the "U"-stitch technique. Ureteral stricture was an independent risk factor for graft loss, while urinary leak was not. Laparoscopic donor technique (compared to open living donor nephrectomy) was not associated with more urinary complications. Our data suggest that several patient characteristics are associated with an increased risk of a urinary complication. The U-stitch technique should not be used for the ureteral anastomosis.