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J Urol. 2017 Mar;197(3 Pt 2):920-924. doi: 10.1016/j.juro.2016.09.120. Epub 2016 Nov 14.

Ureteroureterostomy: An Alternative to Ureteroneocystostomy in Select Cases of Pediatric Renal Transplantation.

Author information

1
Division of Paediatric Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: frank.penna@sickkids.ca.
2
Division of Paediatric Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Abstract

PURPOSE:

Ureteroneocystostomy is the standard mode of establishing urinary drainage in renal transplantation. However, donor-to-recipient ureteroureterostomy may be considered in the presence of a challenging bladder or an augmented bladder, or when the donor ureter might be compromised or is too short. This approach also preserves a nonrefluxing system with an orthotopic ureteral orifice.

MATERIALS AND METHODS:

We retrospectively reviewed the records of all pediatric renal transplantations in which ureteroureterostomy was performed at a single tertiary care pediatric center over the 12-year period from 2004 to 2015. Ureteroureterostomy was performed in end-to-side fashion from donor-to-recipient ureter. Patients with a history of symptomatic vesicoureteral reflux were excluded from ureteroureterostomy. Parameters were reviewed, including age, gender, source of renal transplantation (deceased or living donor), indications for ureteroureterostomy and complications.

RESULTS:

Primary ureteroureterostomy was performed at 23 of the 213 renal transplantations (10.8%). At transplantation mean ± SD age was 11.7 ± 4.9 years and mean weight was 33.5 ± 18.9 kg. Two secondary ureteroureterostomies were done to salvage the ureter due to complications after ureteroneocystostomy. Of the patients 60% and 40% underwent ureteroureterostomy during deceased and living donor renal transplantation, respectively. The most common indications included a challenging small bladder due to anuria, a valve bladder and a neurogenic augmented bladder. Two urinary leaks (8%) occurred and no allografts were lost.

CONCLUSIONS:

Ureteroureterostomy is a safe alternative to standard ureteroneocystostomy in renal transplantation. Ureteroureterostomy should be considered a primary option in certain complex situations and secondarily as a salvage procedure when ureteral problems develop after ureteroneocystostomy in patients who undergo renal transplantation.

KEYWORDS:

chronic; kidney failure; kidney transplantation; salvage therapy; ureter; ureterostomy

PMID:
27855273
DOI:
10.1016/j.juro.2016.09.120
[Indexed for MEDLINE]

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