Alberts V P, Minnee R C, Bemelman F J, van Donselaar-van der Pant K A M I, Laguna Pes P, Idu M M
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Urol Int. 2012;88(3):333-7. doi: 10.1159/000335329. Epub 2012 Jan 24.
The incidence of urological complications after renal transplantation ranges from 2.5 to 30%. Often surgical revision is necessary. The risk factors for surgical revision and which surgical techniques to apply are not elucidated. This study investigates the outcome and risk factors for surgical revision of the ureterocystostomy.
Between January 1995 and March 2009, 1,157 consecutive kidney transplantations were performed. All patient charts and surgical reports were reviewed.
Urological complications occurred in 142 (12.3%) patients. In 60 patients (5.2%) surgical revision was necessary. Of these 60 patients, 43 (71.7%) received neoureterocystostomy, 10 (16.7%) ureteropyelostomy reconstruction and 7 (11.7%) other techniques. Independent risk factors for surgical revision were donor ureteral reconstruction (odds ratio (OR) 48.66, 95% confidence interval (CI) 5.01-472.97), recipient age <18 years (OR 4.85, 95% CI 1.50-15.72) and delayed graft function (OR 2.70, 95% CI 1.36-5.36). Ureteral stenting was a protective factor for surgical revision (OR 0.30, 95% CI 0.12-0.81). The urological complication rates after neoureterocystostomy, ureteropyelostomy reconstruction and other techniques were 16, 0 and 0%, respectively. The overall surgical success rate was 92%.
Ureteral stenting, recipient age, delayed graft function and perioperative ureteral reconstruction are significant factors associated with surgical revision of the ureterocystostomy. Surgical revision of the ureterocystostomy is a successful therapy with a low recurrence rate.
肾移植后泌尿系统并发症的发生率在2.5%至30%之间。通常需要进行手术修复。手术修复的风险因素以及应采用何种手术技术尚未明确。本研究调查了输尿管膀胱吻合术手术修复的结果及风险因素。
在1995年1月至2009年3月期间，连续进行了1157例肾移植手术。回顾了所有患者的病历和手术报告。
142例（12.3%）患者出现泌尿系统并发症。60例（5.2%）患者需要进行手术修复。在这60例患者中，43例（71.7%）接受了新输尿管膀胱吻合术，10例（16.7%）进行了输尿管肾盂吻合术重建，7例（11.7%）采用了其他技术。手术修复的独立风险因素包括供体输尿管重建（比值比（OR）48.66，95%置信区间（CI）5.01 - 472.97）、受体年龄<18岁（OR 4.85，95% CI 1.50 - 15.72）以及移植肾功能延迟（OR 2.70，95% CI 1.36 - 5.36）。输尿管支架置入是手术修复的保护因素（OR 0.30，95% CI 0.12 - 0.81）。新输尿管膀胱吻合术、输尿管肾盂吻合术重建及其他技术后的泌尿系统并发症发生率分别为16%、0%和0%。总体手术成功率为92%。
输尿管支架置入、受体年龄、移植肾功能延迟及围手术期输尿管重建是与输尿管膀胱吻合术手术修复相关的重要因素。输尿管膀胱吻合术的手术修复是一种成功率高、复发率低的治疗方法。
