Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
J Surg Res. 2013 May 1;181(1):156-9. doi: 10.1016/j.jss.2012.05.043. Epub 2012 Jun 1.
Ureteroneocystostomy (UCN) is the most widely used urinary reconstruction technique during kidney transplantation. Disadvantages of this technique include a high incidence of hematuria and reflux, plus the potential for obstruction resulting from distal ureteral fibrosis. Pyeloureterostomy (PU) avoids these complications but increases the technical complexity.
Between January 1990 and December 2005, 1066 adults patients underwent kidney transplantations; 768 patients (72.1%) had urinary reconstruction by PU and 298 (27.9%) underwent UNC.
Patients in the PU group underwent simultaneous ipsilateral native nephrectomy. The operative time was longer in the PU group compared with the UNC group: 210 ± 36 min versus 182 ± 24 min (P < 0.001). Overall surgical complications in the PU group were comparable to those in the UNC group (9.5% versus 12.3%). The urinary complication rate was also comparable in both groups: 3.2% (25 of 768) in the PU group and 5% (15 of 298) in the UNC group. However, urinary obstruction comprised 60% of urinary complications in the UNC group, compared with 32% in the PU group (P < 0.01). We treated most urinary complications non-operatively. However, 24% of patients (six of 25) in the PU group needed operative intervention or revision for ureteral reconstruction, compared with 46.6% (seven of 15) in the UNC group (P < 0.01).
Pyeloureterostomy is a safe and effective method for urinary tract reconstruction in renal transplantation. Pyeloureterostomy should be part of every transplant surgeon's armamentarium.
输尿管膀胱再植术（UCN）是肾移植过程中最广泛应用的尿路重建技术。该技术的缺点包括血尿和反流发生率高，以及远端输尿管纤维化导致梗阻的潜在风险。肾盂输尿管吻合术（PU）可避免这些并发症，但增加了技术复杂性。
1990 年 1 月至 2005 年 12 月，1066 例成人患者接受了肾移植；768 例（72.1%）患者采用 PU 进行尿路重建，298 例（27.9%）患者采用 UCN。
PU 组患者同期行同侧原位肾切除术。与 UCN 组相比，PU 组的手术时间更长：210±36min 比 182±24min（P<0.001）。PU 组的总体手术并发症与 UCN 组相当（9.5%比 12.3%）。两组的尿并发症发生率也相似：PU 组为 3.2%（25/768），UCN 组为 5%（15/298）。然而，UCN 组的尿梗阻占尿并发症的 60%，而 PU 组为 32%（P<0.01）。我们对大多数尿并发症进行了非手术治疗。然而，PU 组中有 24%（25 例中的 6 例）需要手术干预或重新进行输尿管重建，而 UCN 组中有 46.6%（15 例中的 7 例）（P<0.01）。
肾盂输尿管吻合术是肾移植中安全有效的尿路重建方法。肾盂输尿管吻合术应成为每位移植外科医生的必备技术。
