Portal de Periódicos da CAPES

Should Routine Pyeloureterostomy be Advocated in Adult Kidney Transplantation? A Prospective Study of 283 Recipients

2010; Lippincott Williams & Wilkins; Volume: 184; Issue: 5 Linguagem: Inglês

10.1016/j.juro.2010.06.144

1527-3792

Marc‐Olivier Timsit, Fanny Lalloué, Araz Bayramov, Mélissa Taylor, Claire Billaut, Christophe Legendre, Henri Kreis, Lionel Badet, Arnaud Méjean,

Pediatric Urology and Nephrology Studies

No AccessJournal of UrologyAdult Urology1 Nov 2010Should Routine Pyeloureterostomy be Advocated in Adult Kidney Transplantation? A Prospective Study of 283 Recipients Marc-Olivier Timsit, Fanny Lalloué, Araz Bayramov, Melissa Taylor, Claire Billaut, Christophe Legendre, Henri Kreis, Lionel Badet, and Arnaud Méjean Marc-Olivier TimsitMarc-Olivier Timsit Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France , Fanny LallouéFanny Lalloué Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France , Araz BayramovAraz Bayramov Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France , Melissa TaylorMelissa Taylor Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris , Claire BillautClaire Billaut Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France , Christophe LegendreChristophe Legendre Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France , Henri KreisHenri Kreis Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France , Lionel BadetLionel Badet Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France , and Arnaud MéjeanArnaud Méjean Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France View All Author Informationhttps://doi.org/10.1016/j.juro.2010.06.144AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Ureteroneocystostomy surgical techniques have been repeatedly debated in the medical literature, in contrast to pyeloureterostomy, which is merely considered a salvage procedure. We assessed urological complications and their management after routine pyeloureterostomy in adult kidney transplantation cases. Materials and Methods: We performed a 2-center, uncontrolled, prospective study from January to December 2007. We compared results in 151 consecutive kidney transplantations with routine pyeloureterostomy (group 1) and in 129 procedures with extravesical anti-reflux ureteroneocystostomy (group 2). Perioperative ureteral stenting was done on demand in each group. Major complications included complex leakage, stenosis and surgical revision. Transient leakage or obstruction less than 15 days in duration were considered minor complications. Results: Recipients in group 1 were more likely to undergo ureteral stenting on demand than those in group 2 (68.9% vs 21.7%). The incidence of overall complications was similar in groups 1 and 2 (9.3% and 13.2%, respectively, p = 0.15), although the major complication rate was higher in group 2. Group 1 recipients had a tendency to require long-term ureteral stenting more often. The only recipient with ureteral necrosis in group 1 was treated with surgical resection and repeat end-to-end ureteroureterostomy. In each group no graft was lost due to urological complications or their management. Conclusions: Routine pyeloureterostomy is a safe technique that may be a valuable alternative to ureteroneocystostomy for adult renal transplantation. It does not preclude further open re-intervention. Its main advantages include a significant decrease in the risk of surgical re-intervention, the opportunity to perform further endourological procedures on the allograft urinary system and the avoidance of vesicoureteral reflux. References 1 : Urological complications in renal transplantation: impact of a change of technique. Br J Urol1997; 79: 499. Google Scholar 2 : Stented versus nonstented extravesical ureteroneocystostomy in renal transplantation: a meta-analysis. Am J Transplant2004; 4: 1889. Google Scholar 3 : Attempt at renal homograft (maternal kidney) after nephrectomy for traumatism of a lone kidney. Mem Acad Chir1953; 79: 642. Google Scholar 4 : Secondary pyelo-pyelic anastomosis in renal transplant patients. Urology1990; 36: 183. Google Scholar 5 : Pyeloureterostomy in the management of renal allograft ureteral complications: an alternative technique. J Urol1993; 149: 366. Link, Google Scholar 6 : Experience with pyeloureterostomy in renal transplantation. Ann Surg1982; 196: 588. Google Scholar 7 : Ureteropyelostomy with a monofilament absorbable suture. Transplantation1987; 44: 459. Google Scholar 8 : Extravesical ureteral implantation in kidney transplantation. Urology1974; 3: 304. Google Scholar 9 : Urological complications after 2084 consecutive kidney transplantations. Transplant Proc1997; 29: 152. Google Scholar 10 : Surgical complications of kidney transplantation. J Nephrol1998; 11: 137. Google Scholar 11 : Routine stenting reduces urologic complications as compared with stenting "on demand" in adult kidney transplantation. Urology2007; 70: 893. Google Scholar 12 : Venous ischemia as a cause of ureteral necrosis in transplanted ureters. J Pediatr Surg1999; 34: 1725. Google Scholar 13 : Urological complications in renal transplantation: A comparison between living-related and cadaveric grafts. Eur Urol1997; 31: 433. Google Scholar 14 : Urological complications after renal transplantation using ureteroureteral anastomosis in children. J Urol2001; 166: 1046. Link, Google Scholar 15 : External ureteroneocystostomy and ureteroureterostomy in renal transplantation. Ann Surg1979; 190: 663. Google Scholar 16 : Re-establishment of urinary continuity by uretero-ureterostomy in renal transplantation: Apropos of 135 cases. J Urol (Paris)1985; 91: 27. Google Scholar 17 : Ligation of the native ureter in renal transplantation. J Urol2002; 167: 29. Link, Google Scholar 18 : Experience with pyeloureterostomy associated with simple ligation of native ureter without ipsilateral nephrectomy in renal transplantation. J Urol1985; 133: 386. Link, Google Scholar 19 : Vesicoureteric reflux following renal transplantation: significance and risks. Transplant Proc1994; 26: 2191. Google Scholar 20 : A critical appraisal of vesicoureteral reflux in long-term renal transplantation recipients: prospective study. Transplant Proc1997; 29: 136. Google Scholar 21 : Risks of vesicoureteric reflux in the transplanted kidney. N Engl J Med1977; 297: 414. Google Scholar 22 : Incidence of vesico-ureteral reflux after allograft renal transplantation. Transplant Proc1994; 26: 292. Google Scholar 23 : Incidence of urinary tract infections and vesicorenal reflux: a comparison between conventional and antirefluxive technique of ureter implantation. Transplant Proc1992; 24: 2773. Google Scholar 24 : Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant2007; 7: 899. Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLopes R, Fernandez N, Koyle M, dos Santos J, Perez J, Romao R and Lorenzo A (2018) Clinical Outcomes of the Upper Urinary Tract after Ureteral Clipping for Treatment of Low Functioning or Nonfunctioning Renal MoietiesJournal of Urology, VOL. 199, NO. 2, (558-564), Online publication date: 1-Feb-2018.Penna F, Lorenzo A, Farhat W, Butt H and Koyle M (2016) Ureteroureterostomy: An Alternative to Ureteroneocystostomy in Select Cases of Pediatric Renal TransplantationJournal of Urology, VOL. 197, NO. 3 Part 2, (920-924), Online publication date: 1-Mar-2017.Canning D (2018) Re: Laparoscopic Ureteral Ligation (Clipping): A Novel, Simple Procedure for Pediatric Urinary Incontinence Due to Ectopic Ureters Associated with Non-Functioning Upper Pole Renal MoietiesJournal of Urology, VOL. 195, NO. 1, (168-170), Online publication date: 1-Jan-2016.Verrier C, Bessede T, Hajj P, Aoubid L, Eschwege P and Benoit G (2018) Decrease in and Management of Urolithiasis After Kidney TransplantationJournal of Urology, VOL. 187, NO. 5, (1651-1655), Online publication date: 1-May-2012. Volume 184Issue 5November 2010Page: 2043-2048 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordsanastomosisuretervesico-ureteral refluxkidneykidney transplantationsurgicalMetricsAuthor Information Marc-Olivier Timsit Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France More articles by this author Fanny Lalloué Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France More articles by this author Araz Bayramov Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France More articles by this author Melissa Taylor Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris More articles by this author Claire Billaut Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France More articles by this author Christophe Legendre Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France More articles by this author Henri Kreis Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Department of Nephrology and Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France More articles by this author Lionel Badet Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Lyon I University, Lyon, France More articles by this author Arnaud Méjean Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Division of Urology and Renal Surgery, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France More articles by this author Expand All Advertisement PDF downloadLoading ...