PURPOSE

The aim of this study was to compare extravesical seromuscular tunnel lengthening technique with uretero-ureteral/pyelo-ureteral anastomosis techniques in post-transplant vesicoureteral reflux (VUR) management.

MATERIALS AND METHODS

We retrospectively reviewed the charts of 46 patients with post-transplant VUR who underwent reflux correction surgery. 8 patients were excluded due to history of biopsy proven rejection episodes, a previous surgical operation for VUR correction, long-term diabetes, neuromuscular bladder dysfunction or urethral stricture. Remaining 38 patients were included in the study. Patients were divided into two groups according to the type of surgery: Group I consisted of 20 patients with refluxing native ureters who were treated with extravesical seromuscular tunnel lengthening technique while Group II consisted of 18 patients with non-refluxing native ureters who were treated with uretero-ureteral or pyelo-ureteral anastomosis using native ureters.

RESULTS

Mean operative time was significantly shorter in Group I compared to Group II (64.8 vs. 110.1, p<0.001) and mean duration of hospital stay was also shorter in Group I (1.5 vs. 5.1, p<0.001). No complication was encountered in Group I, however, complications occurred in 3 patients (16.6%) in Group II (a lymphocele, urinary leakage in one case and a ureteral obstruction), but that was not statistically significant (p>0.05). We determined persistent VUR in postoperative voiding cystouretrography in 2 (10%) patients in Group I, but there was regression in VUR grades of both of these patients. There was no statistically significant difference between extravesical seromuscular tunnel lengthening and uretero-ureteral/pyelo-ureteral anastomosis techniques in terms of VUR resolution (p=0.48). The two goups were similar in regards to postoperative number of urinary tract infection episodes (UTI) and serum creatinine levels (p>0.05).

CONCLUSIONS

Extravesical seromuscular tunnel lengthening procedure may be performed in patients with refluxing native ureters providing reasonable outcomes in terms of decreasing number of recurrent symptomatic UTI episodes and preventing renal graft damage with low morbidity and significantly shorter operative time and hospital stay.

CITATION INFORMATION: Turunç V, Eroğlu A, Tabandeh B, Dheir H, Basok E, Erol A. Comparison of Surgical Correction Techniques for Post-Kidney Transplantation Vesicoureteral Reflux. Am J Transplant. 2016;16 (suppl 3).

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