Thiounn N, Benoit G, Osphal C, Charpentier B, Bensadoun H, Hiesse C, Moukarzel M, Neyrat N, Bellamy J, Lantz O
Service d'Urologie, Hôpital de Bicêtre, Université Paris-Sud, France.
Prog Urol. 1991 Aug-Sep;1(4):531-8.
1,224 renal transplant patients were studied. 50 kidneys were obtained from living related donors. The mean age of the recipients was 34.6 years (16.8 to 67.6 years) Ureteric reimplantation was initially performed by uretero-ureteric anastomosis (19%), then into the bladder according to the Leadbetter-Politano technique (69%) and subsequently according to the Lich-Gregoire extra-vesical technique (10%). A cutaneous ileostomy or reimplantation into the renal pelvis was performed in the remaining 2% of cases. The risk of one or more urological complications was 11.2% (137/1,224) and 7.9% when only those patients requiring surgical intervention were taken into account. These complications were classified into 3 categories: strictures (60.6%), fistulae (35.8%) and stones (6.6%). The frequency of urological complications was lower with the Lich-Gregoire technique (4.1%) which we have currently adopted. The renal transplant was lost in 6.1% of cases directly related to a urological complication. The presence of urinary tract fistulae had an unfavourable influence on graft survival due to detransplantations. Whenever possible, our preferred approach consists of percutaneous and/or endourological techniques as first-line treatment followed by second-line surgical treatment in the event of failure of the percutaneous approach.
