Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America.
Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, United States of America.
PLoS One. 2021 Jan 11;16(1):e0244248. doi: 10.1371/journal.pone.0244248. eCollection 2021.
Urologic complications can still occur following kidney transplantation, sometimes requiring multiple radiological and/or surgical procedures to fully correct the problem. Previously proposed extravesical ureteral reimplantation techniques still carry non-negligible risks of the patient developing urologic complications. About 10 years ago, a new set of modifications to the Lich-Gregoir technique was developed at our center, with the goal of further minimizing the occurrence of urologic complications, and without the need for initial ureteral stent placement. It was believed that an improvement in the surgical technique to minimize the risk of developing urologic complications was possible without the need for stent placement at the time of transplant. In this report, we describe the advantages of this technique (i.e., mobilized bladder, longer spatulation of the ureter, inclusion of bladder mucosa with detrusor muscle layer in the ureteral anastomosis, and use of a right angle clamp in the ureteral orifice to ensure that it does not become stenosed). We also retrospectively report our experience in using this technique among 500 consecutive (prospectively followed) kidney transplant recipients transplanted at our center since 2014. During the first 12mo post-transplant, only 1.4%(7/500) of patients developed a urologic complication; additionally, only 1.0%(5/500) required surgical repair of their original ureteroneocystostomy. Five patients(1.0%) developed a urinary leak, with 3/5 having distal ureteral necrosis, and 1/5 subsequently developing a ureteral stricture. Two other patients developed ureteral stenosis, one due to stricture and one due to ureteral stones. These overall results are excellent when compared with other reports in the literature, especially those in which routine stenting was performed. In summary, we believe that the advantages in using this modified extravesical ureteroneocystostomy technique clearly help in lowering the early post-transplant risk of developing urologic complications. Importantly, these results were achieved without the need for ureteral stent placement at the time of transplant.
肾移植后仍可能发生泌尿科并发症，有时需要多次放射学和/或手术来完全纠正问题。先前提出的经膀胱外输尿管再植入技术仍然存在患者发生泌尿科并发症的不可忽视的风险。大约 10 年前，我们中心对 Lich-Gregoir 技术进行了一系列新的修改，目的是进一步降低泌尿科并发症的发生几率，并且无需在移植时放置初始输尿管支架。当时认为，改进手术技术以降低发生泌尿科并发症的风险是可能的，无需在移植时放置支架。在本报告中，我们描述了该技术的优点（即活动膀胱、更长的输尿管切开术、包括膀胱黏膜与逼尿肌层在内的输尿管吻合术，以及在输尿管口使用直角钳以确保其不会变狭窄）。我们还回顾性报告了自 2014 年以来我们中心 500 例连续（前瞻性随访）肾移植受者使用该技术的经验。在移植后 12 个月内，只有 1.4%（7/500）的患者发生了泌尿科并发症；此外，只有 1.0%（5/500）的患者需要对其原始的输尿管-膀胱吻合术进行手术修复。5 例患者（1.0%）发生尿漏，其中 3 例为远端输尿管坏死，1 例随后发生输尿管狭窄。另外 2 例患者发生输尿管狭窄，1 例因狭窄，1 例因输尿管结石。与文献中的其他报告相比，这些结果非常出色，尤其是那些常规支架置入的报告。总之，我们认为使用这种改良的经膀胱外输尿管-膀胱吻合术技术的优点有助于降低移植后早期发生泌尿科并发症的风险。重要的是，这些结果是在移植时无需放置输尿管支架的情况下实现的。
