COMPLICATION OF EXTRA VESICAL URETERONEOCYSTOSTOMY IN LIVING DONOR RENAL TRANSPLANTATION
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Abstract
Reconstruction of urinary system during renal transplantation is usually performed with anti-refluxivc uretero- ncocystostomy technigucs and extra-vesical methods are usually preferred.
Between 1983-1997, 241 renal transplantations from living donors were performed at our institulion. a variali- on of Lich — Gregoir technigue was used as ureteroncocystostomy method in all cases.
A total of 14 (5,8644) urologic complications Were observed. Urinary fistula developed in 5 (25) cases that were all diagnosed during the early postoperative term and were explored surgically. The ureteral anastomosis Was renewed in 3 while the remaining 2 in 9 (3,794) cases. Renewing the extravesical ureleroncocystostomy successfuliy treated posloperative VUR to the transplanted kidney in | case. Subureteral Teflon injection was performed in2 pa- tenis; but for one of them only intravesical ureteroncocpystostomy (Politano-Leadbetier) resolved the VUR. VUR, considered to be secondary to uretheral stricture, resolved after endoscopic intern”! “rethrotomy. Nephrectomy was performed in | patieni with VUR to his native kidney. The remaining 3 cases Who did not need surgical intervention are followed-up.
Urologic complications after renal transplantation are reported to be 467 and ischemia is blamcd to be iheir ma- jor contributing factor. Morover, preparation of the native ureter during donor nephrectomy and preservation of dis- tal periurethral fatiy tissue, technigue of anaslomosis, variations in vascular analomy, rejections and medications are ihe factor delermining the ischemia.