Complicaciones urológicas postrasplante renal con técnica de Lich-Gregoir: experiencia de cuatro años / Urological complications following kidney transplantation using Lich-Gregoir technique: a 4-year experience in Mexico

Objetivo: Revisión de las complicaciones urológicas posteriores al trasplante renal en dos centros hospitalarios utilizando la técnica de ureteroneocistostomía extravesical de Lich-Gregoir en un periodo de cuatro años. Material y métodos: Se revisaron los expedientes de 242 pacientes en quienes se llevó a cabo trasplante renal de enero de 2003 a noviembre de 2007. En todos los pacientes se realizó ureteroneocistostomía extravesical. Se informaron todas las complicaciones urológicas y su manejo. Resultados: Se registraron 19 complicaciones en 18 pacientes, con una incidencia de 7.8 %; 16 riñones se obtuvieron de donadores vivos. Las complicaciones más comunes fueron fuga de orina (4.5 %), estenosis urinaria (1.6 %), reflujo vesicoureteral (1.2 %) y necrosis ureteral (0.4 %). La mayoría de los pacientes fueron tratados con sonda de Foley (42 %), colgajo de Boary (26 %) y nefrostomía (15 %). La pérdida del injerto renal se asoció a complicaciones urológicas en 1.23 % Conclusiones: El trasplante renal debe incurrir en pocas complicaciones urológicas, por lo que debe cuidarse los detalles técnicos. La evaluación temprana para corregir las complicaciones reduce la sepsis, morbilidad y el riesgo de pérdida del injerto.

OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.

Urologic Complication of Extravesical Ureteroneocystostomy in Renal Transplantation / 대한비뇨기과학회지

Since the first successful kidney transplant in 1954, many advances have been made in renal transplantation technique and urinary reconstruction. Recently, there has been increasing interest in the use of extravesical technique to perform ureteroneocystostomy in renal transplantation. From January 1985 to September 1994, 93 patients underwent renal transplant ureteroneocystostomy by an extravesical technique. Complications related to the anastomosis and/or ureter were reviewed. There were 5 total complications, for an over-all urologic complication rate 5.4 percent. Of these complications one was related to the ureteroneocystostomy, for an anastomotic complication rate of 1.07 percent We report our experience with the simple extravesical technique for ureteroneocystostomy that has provided excellent results and minimal morbidities.

Experimental Studies on Extravesical Ureteroneocystostomy in Dogs / 대한비뇨기과학회지

We have performed experimental bilateral extravesical Ureteroneocystostomy in dogs. The technique of procedure was as follows : A longitudinal myotomy incision was made near the bladder dome directed forward the bladder neck for 2cm and then separated to allow the mucosa to pout. A 1 cm incision was then made in the bladder mucosa at the distal end of the detrusor incision. Excess ureter was excised and the ureter spatulated for 1 cm. A 6-0 Prolene suture was then placed at each apex and fullthickness of ureter anastomosed to the bladder mucosa in one layer with a continuous, nonlocking stitch. The myotomy incision was then closed over the ureter with interrupted 4-0 chromic catgut. The surgical wound was closed without drains. The roentgenographic findings and gross findings of the ureter and kidney were observed on the 3 wks after the operation For microscopic observation of the ureteroneocystostomy site were observed. The results are as follows: 1. Retrograde cystographic finding showed on ureterovesical reflux in 6 dogs. 2. Intravenous urographic findings were no hydronephrosis and dye were well drained into the bladder, except 1 dog which showed severe hydronephrosis on right kidney and mild hydronephrosis on left kidney. 3. Gross findings of ureter and kidney revealed no obstruction and renal enlargement, except one dog showed incomplete bilateral obstruction on ureteroneocystostomy site.

Extravesical Ureteroneocystostomy in Renal Transplantation / 대한비뇨기과학회지

10 cases of renal transplantation was performed in Han Yang University from April, 1978 to August, 1978. And we used the technique of extravesical ureteroneocystostomy for anastomosis of transplant ureter to recipient bladder. The ureteral complication was occurred in 1 case, that was ureteral leakage, in all of them.