*Purpose: Ureteral anastomosis (Uretero-Neocystostomy) is considered the “Achilles Heel” of Renal transplant (RT).Few studies of Primary Uretero-Ureterostomy (U-U) in RT have been reported. Primary U-U has an advantage of removing Foley earlier, shorter hospital stay, less incidence of lymphocele & less need for Secondary U-U.

*Methods: We are reporting our experience with 103 consecutive patients in whom we used the technique of U-U in RT & compared with 48 RT performed during same time period with Uretero-Neocystostomy(U-N) by another surgeon who preferred to do only U-N. Since May 2016, the data on all RT were collected, including age, sex, type of U-U vs U-N, OR time, duration of Foley in place, hospital stay, estimated blood loss, incidence of leak & stricture formation, graft & patient survival.

*Results: During this time period 151 RT were performed (Cadaveric-96, Living donor-17, Liver-kidney 8, Kidney-Pancreas -30) by 3 surgeons, 2 of whom did U-U for their patients (n=103) & the 3^rd surgeon did U-N for all his patients (n=48). Four patients by the 1^st two surgeons did receive U-N either due to ureteral reflux as cause of ESRD or lack of adequate ureter due to previous nephrectomy & ureterectomy. There was no difference in mean age (50.8 vs 46.2), sex (M:F -46:31 vs 20:16), estimated blood loss (166.7 vs 187.5 ml), duration of Foley in place (6.2 vs 6), length of hospital stay (5.3 vs 5.2), urine leak(1 vs 1), graft survival (97.5 vs 97.2 %) & patient survival (94.8 vs 97.2%) between 2 groups except OR time (2:4 vs 3.1 hrs.) and stricture formation(0% vs 5.5%).

*Conclusions: Even though this study is not randomized by design, it is essentially randomized, as it was merely by chance of the call schedule that patients received RT by surgeons performing U-U, rather than surgeon performing U-N. Although we are reporting the results in the above 2 groups, when including all our patients who underwent RT, plus either liver or pancreas transplant, too, the result was still the same in incidence of leak, stricture, graft & patient survival. Due to shorter observation time, we do not have reports of secondary U-U in these RT patients; however in the long run 10-14% of RT with U-N will need secondary U-U. We did not remove Foley earlier due to traditional practices but believe it can be removed earlier (post-op day 1) in U-U in contradistinction to U-N, thereby reducing patient’s hospital stay. Thus we conclude U-U decreases OR time, Stricture formation & need for secondary U-U in RT patients.

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