Bardonnaud N, Pillot P, Guichard G, Lillaz J, Delorme G, Nguyen-Huu Y, Chabannes E, Bernardini S, Bittard H, Kleinclauss F
Service d'urologie et transplantation rénale, hôpital Saint-Jacques, CHU de Besançon, 2, place Saint-Jacques, 25030 Besançon, France.
Prog Urol. 2012 Jan;22(1):22-9. doi: 10.1016/j.purol.2011.08.040. Epub 2011 Oct 12.
To assess urinary complications related to the "one-stitch" technique extravesical ureteroneocystostomy in renal transplantation, and evaluate the impact of such complications on kidney graft and patient survival.
A single-institution, retrospective study was performed on 202 renal transplant recipients, from January 2004 to December 2008. Two combined kidney and liver transplantations were excluded. The "one-stitch" extravesical ureteroneocystostomy technique, fast and easy to perform, was systematically used. The evaluated urinary complications were urinary fistula, ureteral stenosis, symptomatic ureteral reflux, stone formation and complicated hematuria. We tried to point out factors impacting urinary complications occurrence and studied grafts and patients survival according to the existence of urinary complications.
Fifty-five patients presented urinary complications (27.5%). The most frequent urinary complications were complicated hematuria (36 over 200, 18%), ureteral stenosis (15 over 200, 7.5%). Few cases of stone disease (one over 200, 0.5%), urinary fistula (two over 200, 1%) and symptomatic ureteral reflux (one over 200, 0.5%) were noted. Male gender (100 vs 34, P=0.95), age (46.78 ± 14.17 vs 48.06 ± 14.19 years, P=0.58), Body mass index (24.14 ± 5.04 vs 24.28 ± 4.83, P=0.86) and past history of renal transplantations (16 ± 3% vs 10 ± 3%, P=0.27) as well as cold ischemia time (17.08 ± 7.07 vs 16.9 ± 8.95 hours, P=0.71) were not significantly different in the urinary complications group and the non-urinary complications group. Median hospitalization time was similar in both groups (14 vs 12 days, P=0.37). The existence of urinary complications didn't affect the 5 years kidney graft survival (91.9% vs 89.9%, HR 1.21, CI 95% [0.37-3.3], P=0.83) neither the 5 years patient survival (94.8% vs 92.15%, HR 0.52 CI 95% [0.13-2.07], P=0.85).
If benign urinary complications in "one-stitch" ureteroneocystostomy were frequent in our study (17% grade II Clavien Dindo), kidney graft and patients survivals were not affected.
评估肾移植中“一针法”膀胱外输尿管膀胱吻合术相关的泌尿系统并发症，并评估此类并发症对肾移植和患者生存的影响。
对2004年1月至2008年12月期间的202例肾移植受者进行了单中心回顾性研究。排除2例肝肾联合移植。系统采用了操作快速简便的“一针法”膀胱外输尿管膀胱吻合术。评估的泌尿系统并发症包括尿瘘、输尿管狭窄、有症状的输尿管反流、结石形成和复杂性血尿。我们试图指出影响泌尿系统并发症发生的因素，并根据是否存在泌尿系统并发症研究移植肾和患者的生存情况。
55例患者出现泌尿系统并发症（27.5%）。最常见的泌尿系统并发症是复杂性血尿（200例中有36例，18%）、输尿管狭窄（200例中有15例，7.5%）。记录到少数结石病病例（200例中有1例，0.5%）、尿瘘（200例中有2例，1%）和有症状的输尿管反流（200例中有1例，0.5%）。泌尿系统并发症组和非泌尿系统并发症组在性别（100例对34例，P = 0.95）、年龄（46.78 ± 14.17岁对48.06 ± 14.19岁，P = 0.58）、体重指数（24.14 ± 5.04对24.28 ± 4.83，P = 0.86）、既往肾移植史（16 ± 3%对10 ± 3%，P = 0.27）以及冷缺血时间（17.08 ± 7.07小时对16.9 ± 8.95小时，P = 0.71）方面无显著差异。两组的中位住院时间相似（14天对12天，P = 0.37）。泌尿系统并发症的存在既不影响5年移植肾生存率（91.9%对89.9%，风险比1.
