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Wehner H, Wullich B, Kunath F, Apel H. Taguchi versus Lich-Grégoir Extravesical Ureteroneocystostomy in Kidney Transplantation: A Systematic Review. Urol Int 2021; 105:1052-1060. [PMID: 34537774 DOI: 10.1159/000518979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ureteric implantation of the transplanted ureter into native urinary bladder tissue in kidney transplantation recipients is essential for post-operative kidney function. We aimed to determine the effects of Taguchi versus Lich-Grégoir extravesical ureteroneocystostomy in kidney transplantation. METHODS We searched multiple databases (MEDLINE, Cochrane Library, and Web of Science), trial registries, and conference proceedings until March 2021. We included prospective studies comparing Taguchi and Lich-Grégoir ureteroneocystostomy in kidney transplantation. Two review authors independently screened the identified records, extracted data, evaluated the risk of bias using ROBINS-I, and assessed the certainty of evidence according to GRADE. RESULTS We identified 3 prospective studies with serious or critical risk of bias, leading to low-certainty evidence. We downgraded the risk of bias due to study limitations. Assessment and/or reporting of baseline imbalances, co-interventions, and confounding factors was insufficient in all included studies. The effect of Taguchi ureteroneocystostomy remains unclear. CONCLUSION Currently available evidence is not useful to determine the effect of Taguchi versus Lich-Grégoir ureteroneocystostomy in kidney transplantation. There is a need for methodologically better designed and executed studies, such as randomized controlled trials with long-term follow-up reporting baseline imbalances, co-interventions, and confounding factors.
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Affiliation(s)
- Hannah Wehner
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Pinto H, Leal R, Rodrigues L, Santos L, Romãozinho C, Macário F, Alves R, Bastos C, Roseiro A, Costa F, Campos M, Mota A, Figueiredo A. Surgical Complications in Early Post-transplant Kidney Recipients. Transplant Proc 2017; 49:821-823. [DOI: 10.1016/j.transproceed.2017.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abou Youssif TM, Fahmy A, Rashad H, Atta MA. The embedded nipple: An optimal technique for re-implantation of primary obstructed megaureter in children. Arab J Urol 2016; 14:171-7. [PMID: 27493810 PMCID: PMC4963169 DOI: 10.1016/j.aju.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 11/28/2022] Open
Abstract
Objectives To present a novel ureteric re-implantation technique for primary obstructed megaureter (POM) that ensures success in the short- and long-term, as conventional techniques are not ideal for megaureters especially in children, with ureteric stenosis and reflux being common complications after re-implantation. Patients and methods Between 2009 and 2012, 22 paediatric patients with POM were enrolled. We performed a new technique for re-implantation of these ureters to ensure minimal incidence of ureteric strictures and easy subsequent endoscopic access. We performed follow-up voiding cystourethrography (VCUG) at 6 months postoperatively. Results The cohort comprised 14 boys and eight girls, with a median age of 22 months. Six patients underwent bilateral re-implantation. The mean (range) duration of indwelling ureteric catheterisation was 7.8 (4–14) days. There were no complications in the perioperative and postoperative periods. There was no reflux on follow-up VCUG in any of the patients. One patient developed Grade I reflux after 1 year and presented with a urinary tract infection. Diagnostic cystoscopy was performed in 13 patients showing that the nipple was directed similarly to the native ureteric orifice. Conclusion The embedded-nipple technique for re-implantation of POM guarantees successful results and permits easy subsequent ureteroscopic access when needed.
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Affiliation(s)
- Tamer M Abou Youssif
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Fahmy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hazem Rashad
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohammed Adel Atta
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Van Arendonk KJ, Goldstein SD, Salazar JH, Kumar K, Lau HT, Colombani PM. A nipple-valve technique for ureteroneocystostomy in pediatric kidney transplantation. Pediatr Transplant 2015; 19:42-7. [PMID: 25400105 DOI: 10.1111/petr.12393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/29/2022]
Abstract
The ureteroneocystostomy in kidney transplantation can be performed with a variety of techniques. Over a 20-yr period, we utilized a technique of nipple-valve ureteroneocystostomy for the pediatric kidney transplants performed at our institution. The distal ureter is everted upon itself and anchored in place with four interrupted sutures to create a nipple valve, which is then inserted into the bladder and sewn mucosa-to-mucosa with the same sutures. The muscularis layer is closed around the ureter without tunneling and without routine ureteral stenting. After 109 transplants, patient survival was 97.2, 97.2, and 86.9% at one, five, and 10 yr, respectively. Graft survival was 91.7, 71.7, and 53.9% at one, five, and 10 yr, respectively. The most common cause of graft loss was acute or chronic rejection, seen in 75% of those experiencing graft loss. Two patients (1.8%) developed pyelonephritis in the transplanted kidney. Nipple-valve ureteroneocystostomy in pediatric kidney transplantation is a safe and simple method for performing the ureterovesical anastomosis with a low rate of pyelonephritis after transplantation.
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Affiliation(s)
- Kyle J Van Arendonk
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Baston C, Harza M, Preda A, Gener I, Manea I, Voinea S, Olaru V, Badescu B, Sinescu I. Comparative urologic complications of ureteroneocystostomy in kidney transplantation: transvesical Leadbetter-Politano versus extravesical Lich-Gregoir technique. Transplant Proc 2015; 46:176-9. [PMID: 24507047 DOI: 10.1016/j.transproceed.2013.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The incidence of urologic complications after kidney transplantation remains high despite improvements in diagnosis and operative techniques. Urinary tract reconstruction is usually done by ureteroneocystostomy (UCNS), and several techniques are available. In this study, we evaluated the outcomes of 2 different UCNS techniques performed in our department, the transvesical Leadbetter-Politano (L-P) and the extravesical Lich-Gregoire (L-G) technique. MATERIAL AND METHODS We evaluated the outcomes of 2 different UCNS techniques, L-P versus L-G, performed in our department between July 1, 2006, and December 31, 2011. During this period, we performed 524 consecutive renal transplantations-264 cases using the L-P technique (50.3%) and 260 cases with L-G technique (49.7%). Renal grafts were obtained from cadaveric donors in 146 cases (27.86%) and from living-related donors in 378 cases (72.14%). Recipient mean age was 35.64 years and the male to female ratio was 1.63:1. RESULTS Urologic complications after kidney transplantation occurred in 22 cases in the L-P UCNS group (8.33%). The most common complications were ureteral stenosis (3.41%) and leakage (2.65%). Other complications recorded were lymphoceles (1.89%) and hematoma with secondary ureteral obstruction (0.38%). Compared with the L-P UCNS technique, the L-G technique was associated with fewer overall complications (6.15% vs 8.33%; P = .06), a lesser rate of ureteral stenosis (2.31% vs 3.41%; P = .08), and a similar rate of leakage. However, statistical analysis revealed no differences between the 2 techniques (P = .06). In addition, we did not note any differences in graft and patient survival between the 2 groups. CONCLUSIONS In our study, the extravesical L-G technique has a lower complication rate compared with transvesical L-P procedure, but without statistical differences. Furthermore, the L-G technique is easier and faster to perform, it avoids a separate cystotomy, and requires a shorter ureteral length. In conclusion, we recommend L-G technique as technique of choice in kidney transplantation.
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Affiliation(s)
- C Baston
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - M Harza
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - A Preda
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - I Gener
- Center of Internal Medicine-Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - I Manea
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - S Voinea
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - V Olaru
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - B Badescu
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - I Sinescu
- Center for Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Alberts VP, Idu MM, Legemate DA, Laguna Pes MP, Minnee RC. Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis. Transpl Int 2014; 27:593-605. [PMID: 24606191 DOI: 10.1111/tri.12301] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/28/2013] [Accepted: 03/03/2014] [Indexed: 01/24/2023]
Abstract
No consensus exists about which ureterovesical anastomosis technique to use for kidney transplantation. The aim of this systematic review was to compare the existing techniques in relation to the risk of urological complications. All studies that compared ureterovesical anastomotic techniques in kidney transplantation were included. Study endpoints were urinary leakage, ureteral stricture, vesicoureteral reflux and hematuria. Subanalyses of stented and nonstented techniques were performed. Two randomized clinical trials and 24 observational studies were included. Meta-analyses were performed on the Lich-Gregoir (LG) versus Politano-Leadbetter (PL) techniques and LG versus U-stitch (U) techniques. Compared with the PL technique, the LG technique had a significantly lower prevalence of urinary leakage (risk ratio (RR): 0.47, 95% confidence interval (CI): 0.30 to 0.75) and a significantly lower prevalence of hematuria when compared with both PL and U techniques (RR: 0.28, 95% CI: 0.16 to 0.49 and RR: 0.23, 95% CI: 0.11 to 0.50, respectively), regardless of ureteral stenting. There was no difference in the prevalence of ureteral strictures or vesicoureteral reflux between the various techniques. Of the three most frequently used ureterovesical anastomotic techniques, the LG technique results in fewer urological complications than the PL and U techniques.
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Affiliation(s)
- Victor P Alberts
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Lich-Gregoir Technique and Routine Use of Double J Catheter as the Best Combination to Avoid Urinary Complications in Kidney Transplantation. Transplant Proc 2014; 46:167-9. [DOI: 10.1016/j.transproceed.2013.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pan XM, Xiang HL, Ding CG, Luo ZZ, Tian PX, Xue WJ. Comparative study of one-stitch versus Lich-Gregoir ureterovesical implantation for kidney transplants. World J Urol 2013; 32:1355-61. [PMID: 24306619 DOI: 10.1007/s00345-013-1217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To compare the outcomes of standard Lich-Gregoir technique and a modified one-stitch technique of ureteroneocystostomy in renal transplantation. PATIENTS AND METHODS Data from 645 transplant recipients by two different ureteroneocystostomy techniques were retrospectively reviewed at the first Affiliated Hospital, Medical College of Xi'an Jiaotong University, between January 2002 and December 2007. RESULTS There were 418 recipients in the Lich-Gregoir group and 227 in new one-stitch group. The overall ureteral complication rate for new one-stitch technique was 19.8 % (n = 45) as opposed to 15.79 % (n = 66) for the Lich-Gregoir technique. No significantly different rate of ureteral complications occurred in two groups (P > 0.05). In comparison, there was a higher proportion of hematuria at the limit of statistical significance in new one-stitch group (P < 0.05). Average operative time for the modified one-stitch and Lich-Gregoir techniques was 8.8 ± 1.4 and 21.9 ± 6.1 min, respectively (P < 0.05). Urinary tract infections, delayed graft function and rejection rates were not significantly different between the two groups (P > 0.05). CONCLUSION Although the modified one-stitch technique may predispose patients to higher rates of hematuria, it has no significant difference in ureteral complications compared with the Lich-Gregoir group. Based on this large series and data analyses, we believe that this new technique will become one of our multiple choices in our setting.
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Affiliation(s)
- X M Pan
- Center of Nephropathy, The First Affiliated Hospital, Medical College of Xi'an Jiaotong University, West 277 Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China,
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Lee S, Moon H, Kim TS, Roh Y, Song S, Shin M, Kim J, Kwon C, Joh JW, Lee SK, Huh W, Oh H, Kim SJ. Presence of Vesicoureteral Reflux in the Graft Kidney Does Not Adversely Affect Long-Term Graft Outcome in Kidney Transplant Recipients. Transplant Proc 2013; 45:2984-7. [DOI: 10.1016/j.transproceed.2013.08.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kayler L, Zendejas I, Molmenti E, Chordia P, Schain D, Magliocca J. Kidney transplant ureteroneocystostomy: comparison of full-thickness vs. Lich-Gregoir techniques. Clin Transplant 2012; 26:E372-80. [DOI: 10.1111/j.1399-0012.2012.01655.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Liise Kayler
- Department of Surgery; Montefiore Medical Center; Bronx; NY; USA
| | - Ivan Zendejas
- Department of Surgery; University of Florida; Gainesville; FL; USA
| | - Ernesto Molmenti
- Department of Surgery, North Shore; LIJ Health System; Long Island; NY; USA
| | - Poorvi Chordia
- Department of Medicine; St. Joseph Mercy Hospital; Ann Arbor; MI; USA
| | - Denise Schain
- Department of Medicine; University of Florida; Gainesville; FL; USA
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Bardonnaud N, Pillot P, Guichard G, Lillaz J, Delorme G, Nguyen-Huu Y, Chabannes E, Bernardini S, Bittard H, Kleinclauss F. Complications urinaires après réimplantation urétérovésicale selon la technique du « one-stitch » en transplantation rénale. Prog Urol 2012; 22:22-9. [DOI: 10.1016/j.purol.2011.08.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 08/29/2011] [Accepted: 08/30/2011] [Indexed: 11/17/2022]
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Kayler L, Kang D, Molmenti E, Howard R. Kidney Transplant Ureteroneocystostomy Techniques and Complications: Review of the Literature. Transplant Proc 2010; 42:1413-20. [DOI: 10.1016/j.transproceed.2010.04.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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