Ureteric Anastomoses in Kidney Transplantation: A Comparison of Results following Uretero-pyelostomy and Uretero-cystostomy

Abstract

In 100 consecutive kidney transplantations, uretero-pyelostomy was performed in 32 instances, and uretero-cystostomy in 68. In three instances the method of uretero-cystostomy was Marshall-Paquin uretero-vesico-plasty and in 65 simple implantation using a technique similar to that described by Woodruff et al. Urinary leakage occurred in 11 of the 32 uretero-pyelostomy patients with functioning transplants: in none of the 3 patients with Marshall-Paquin uretero-vesicoplasty and only in 5 of the 60 patients with simple implantation. Incidence of urinary leakage was not related to the nature of the transplant—whether from living or cadaver donor, nor to the time of nephrectomy, nor to the use of intraductal drainage. Urinary leakage occurred in the absence of infection or rejection phenomena.

Treatment of urinary leakage was, in most cases, surgical and, with one exception, effective. No patient died within 6 weeks from urological complications. No transplant loss followed urological complications.

It is concluded that uretero-neo-cystostomy gives rise to fewer primary complications, and is therefore the safer routine method. Simple implantation similar to that described by Woodruff et al. gives primary results equally as good as the more complex and time consuming anti-reflux procedures.