Modified ureteroneocystostomy in kidney transplantation to facilitate endoscopic management of subsequent urological complications.

OBJECTIVES: Urological complications in kidney transplant patients are among serious complications. Endourology has allowed for a less-invasive approach to dealing with these transplant complications. Access to the upper urinary tract in traditionally anterior extravesical ureteroneocystostomy is usually difficult if not impossible.

MATERIALS AND METHODS: We evaluated the results of renal transplantation comparing two techniques of anterior extravesical ureteroneocystostomy (AEVUNC) and posterolateral extravesical ureteroneocystostomy (PLEVUNC). A total of 120 transplant recipients were randomized to either PLEVUNC (group 1, n = 61) or AEVUNC (group 2, n = 59) techniques. Ureteral and nonureteral complications were compared at 36- to 51-month follow-up. The data regarding successful ureteroscopy were also gathered.

RESULTS: The PLEVUNC group had a urological complication rate of 27.9%, which did not significantly differ from those in AEVUNC group (26.1%) (P = 0.1). In the PLEVUNC group, 1- and 3-year graft survivals were 92.6 and 85.2%, respectively, whereas in the AEVUNC group they were 92.3 and 82.7%, respectively (P = 0.08). There were no significant differences between urinary tract infections, delayed graft function, and chronic allograft nephropathy between the two groups (P = 0.1, 0.1 and 0.08, respectively). Three patients (5.6%) in PLEVUNC group and 1 (1.9%) in AEVUNC group developed immediate postoperative hydronephrosis after removal of ureteral stent (P = 0.04). Successful ureteroscopy was achieved in 52 (96.3%), and 39 (75%), of patients in PLEVUNC and AEVUNC groups, respectively (P = 0.001).

CONCLUSIONS: Easy and safe access to the upper urinary tract in transplant recipients can be achieved using a PLEVUNC technique. This facilitates the endoscopic procedures in the case of urological complications and disorders.