Division of Paediatric Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Paediatric Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2017 Mar;197(3 Pt 2):920-924. doi: 10.1016/j.juro.2016.09.120. Epub 2016 Nov 14.
Ureteroneocystostomy is the standard mode of establishing urinary drainage in renal transplantation. However, donor-to-recipient ureteroureterostomy may be considered in the presence of a challenging bladder or an augmented bladder, or when the donor ureter might be compromised or is too short. This approach also preserves a nonrefluxing system with an orthotopic ureteral orifice.
We retrospectively reviewed the records of all pediatric renal transplantations in which ureteroureterostomy was performed at a single tertiary care pediatric center over the 12-year period from 2004 to 2015. Ureteroureterostomy was performed in end-to-side fashion from donor-to-recipient ureter. Patients with a history of symptomatic vesicoureteral reflux were excluded from ureteroureterostomy. Parameters were reviewed, including age, gender, source of renal transplantation (deceased or living donor), indications for ureteroureterostomy and complications.
Primary ureteroureterostomy was performed at 23 of the 213 renal transplantations (10.8%). At transplantation mean ± SD age was 11.7 ± 4.9 years and mean weight was 33.5 ± 18.9 kg. Two secondary ureteroureterostomies were done to salvage the ureter due to complications after ureteroneocystostomy. Of the patients 60% and 40% underwent ureteroureterostomy during deceased and living donor renal transplantation, respectively. The most common indications included a challenging small bladder due to anuria, a valve bladder and a neurogenic augmented bladder. Two urinary leaks (8%) occurred and no allografts were lost.
Ureteroureterostomy is a safe alternative to standard ureteroneocystostomy in renal transplantation. Ureteroureterostomy should be considered a primary option in certain complex situations and secondarily as a salvage procedure when ureteral problems develop after ureteroneocystostomy in patients who undergo renal transplantation.
输尿管与肾盂吻合术是建立肾移植尿液引流的标准方式。然而，在存在挑战性膀胱或增强性膀胱的情况下，或者当供体输尿管受损或过短时，可能需要考虑进行供体输尿管与受体输尿管吻合术。这种方法还可以保留具有原位输尿管口的非反流系统。
我们回顾性分析了 2004 年至 2015 年期间在一家三级儿科中心进行的所有小儿肾移植中接受输尿管与肾盂吻合术的患者记录。输尿管与肾盂吻合术采用供体输尿管与受体输尿管端侧吻合的方式进行。有症状性膀胱输尿管反流病史的患者被排除在输尿管与肾盂吻合术之外。我们回顾了包括年龄、性别、肾移植来源（已故或活体供体）、输尿管与肾盂吻合术的适应证和并发症等参数。
在 213 例肾移植中，有 23 例（10.8%）进行了原发性输尿管与肾盂吻合术。在移植时，平均年龄为 11.7 ± 4.9 岁，平均体重为 33.5 ± 18.9kg。由于输尿管与肾盂吻合术后出现并发症，进行了 2 例继发性输尿管与肾盂吻合术以挽救输尿管。在接受肾移植的患者中，60%和 40%分别进行了已故和活体供体来源的输尿管与肾盂吻合术。最常见的适应证包括由于无尿、瓣膜膀胱和神经源性增强性膀胱导致的挑战性小膀胱。发生了 2 例尿漏（8%），没有丢失移植物。
在肾移植中，输尿管与肾盂吻合术是标准的输尿管与肾盂吻合术的安全替代方法。在某些复杂情况下，输尿管与肾盂吻合术应作为首选方法，在接受肾移植的患者发生输尿管与肾盂吻合术后出现输尿管问题时，作为挽救性手术。
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