[Re-establishment of urinary continuity by uretero-ureterostomy in renal transplantation. Apropos of 135 cases].

Uretero-ureteral anastomosis was performed in 135 patients (40 women and 95 men) during kidney transplantation using either cadaver (120 cases) or living donor (15 cases) organs. The ureter of the retained kidney was linked proximal to the transplantation, whether or not there had been previous contemporary nephrectomy. Results were highly interesting: no mortality, no need to remove graft for urinary complications and no ureteral anastomotic stenosis. Urological complications were absent in 108 cases (80%) while 17 cases (12.6%) developed a urinary fistula, only 5 of which required surgical intervention Hematoma related to the nephrostomy occurred in 6 cases (4.4%) but operation was necessary in only 2 of these cases. Overall need for repeat surgery involved only 7 patients (5.2%) during the month following transplantation. One of 2 cases of hematoma operated upon required partial excision of the transplantation kidney due to the presence of an intraparenchymatous arteriovenous fistula. A curious finding was that of the 17 cases developing fistulae most of them had received live donor kidneys (5/15) whereas only 12 occurred in the 120 cadaver kidney transplants. Prevention of fistulae appears to be assisted by spatulation of the ureter rather than by its bevelled section, and the maintenance of a long ureteral loop to avoid traction. It is suggested that certain postoperative urine losses may be the result of a hyper-diuresis, without actual dehiscence of the anastomosis. In 4 patients with a urine output of more than 1.5 litres at the time of transplantation, the kidney proximal to the ureteral ligature became infected, and a second nephrectomy was necessary in 4 cases.