Vesicoureteral reflux after renal transplantation

Extravesical ureteroneocystostomy in renal transplantation

From October 1970 to January 1986, 808 patients underwent renal transplant ureteroneocystostomy by an extravesical technique. Complications related to the anastomosis and/or ureter were reviewed. There were 23 total complications, for an over-all urological complication rate of 2.8 per cent. Of these complications 17 were related to the ureteroneocystostomy, for an anastomotic complication rate of 2.1 per cent. Complications were almost universally repaired by another operation. Two patients died and 1 lost the allograft because of urological complications.

The transplanted kidney. Diagnostic and interventional radiology

Following kidney allotransplantation a great number of complications threaten the patient and his graft, e.g. acute tubular necrosis, acute and chronic rejection, urologic and vascular complications and complications due to the immunosuppressive treatment. During the last decade a number of technical developments in radionuclide, ultrasonographic and radiographic imaging and intervention has significantly improved the possibility of early recognition and handling of such complications. Knowledge of the capability and limitations of the various techniques is of vital importance for their rational use. The aim of this review article is to give a short description of the various imaging modalities, the rational monitoring of the posttransplant patient, and possible handling of complications by the aid of imaging techniques.

The ureter in renal transplantation

The outcome of kidney transplantation depends on several factors. The quality of the ureter of the transplanted kidney and the technique of its connection with the recipient's urinary tract seem to be two of the most important ones. In this paper the authors analyse the incidence of ureteral complications of the grafted kidney in 99 ureterocystoneostomies performed in conjunction with kidney transplantation. Urinary fistulas occurred in 7, stenosis of the ureter in 3 cases. The diagnostic possibilities and treatment of the complications are discussed.

Vesicoureteric reflux following renal transplantation: a simple method of ureteric implantation

We have used a simple method of ureteroneocystostomy in renal transplant patients. This entails a no-tunnel "drop-in" with a long free segment protruding into the bladder lumen. The incidence of vesicoureteric reflux was investigated in 81 transplant patients who had a follow-up period ranging from 4 months to 15 years (mean 3.7 years); 29 of these patients had recurrent urinary tract infections. Micturating cystography demonstrated reflux in 6 patients (7.4%). In these 6 patients the presence of reflux had no deleterious effect on renal function and the infections were easily controlled with long-term antibiotics. In the 52 patients without injury infection no reflux was demonstrated. The conclusions based on this study indicate that (1) in the absence of recurrent infection there are no indications for micturating cystography and (2) this method of ureteroneocystostomy is expedient and has a low incidence of reflux.

Controversy in renal transplantation: antireflux versus non-antireflux ureteroneocystostomy

A comparison of 118 consecutive nephroureteral allografts suggests that ureteroneocystostomy provides excellent results with (60 cases) or without (52 cases) an antireflex procedure. Reflux was noted in less than 10% of each group after transplantation and no morbidity could be attributed to reflux when it was found. There was no obstruction or anastomotic leakage in either group. The advantages of each procedure are discussed.

Uretero-neo-cystostomy in renal transplantation. Is an antireflux mechanism mandatory?

We report a retrospective analysis of 120 kidney transplantations in which a simple end-to-end ureteric implantation in the bladder without antireflux mechanism was made. From this study no greater incidence of vesico-ureteric reflux could be demonstrated and, even when present, reflux neither interfered with graft function nor caused an increased incidence of recurrent urinary tract infections. The incidence of other urological complications (leakage, obstruction) being equal, this very simple technique yielded in our hands the best results and we recommend its use in kidney transplantation.