Urologic complications of extravesical ureteroneocystostomy in renal transplantation from living related donors

Introduction: Reconstruction of the urinary system during renal transplanta tion is usually performed with anti-refluxive ureteroneocystostomy techniqu es and extravesical methods are usually preferred. Material and Methods: Be tween 1983 and 1997, 241 renal transplantations from living donors were per formed at our institution. A variation of the Lich-Gregoir technique was us ed as the ureteroneocystostomy method in all cases. Results: A total of 12 (4.9%) urologic complications were observed. Urinary fistula developed in 5 (2%) cases and were explored surgically during the early postoperative per iod. Postoperative vesicoureteral reflux (VUR) to the transplanted kidney w as identified in 7 (2.9%) cases. Either endoscopic or surgical intervention s resolved VUR in 4 cases while the other 3 did not need further treatment. No ureteral stenosis was observed. There was no loss of graft due to urolo gic complications. Conclusions: Urologic complications after renal transpla ntation are reported to be about 7% and ischemia is blamed as the major con tributing factor. Preparation of the native ureter during donor nephrectomy and preservation of distal periureteral fatty tissue, anastomosis techniqu e variations in vascular anatomy, rejections and medications are the major factors determining the ischemia. Copyright (C) 2000 S. Karger AG. Basel.