Introduction:

Ureter anastomosis is considered the achilles heel of renal transplant. Different types of Uretero-neocystostomy anastomosis techniques have been used as well as Uretero-Ureterostomy but latter technique fell out of favor for not a particular reason. Our center resurrected this technique and we are reporting our initial experience with renal transplant Uretero-ureterostomy anatomosis.

Methods:

Since 2008 we have performed 25 ( 22 of them in the last 9 months) Primary Uretero-ureterostomy in 17cadaveric kidney transplant , 3 living related kidney transplant, 3 kidney pancreas transplant and 2 liver kidney transplant. Double J stent placed, removed 6 weeks after transplant. All anastomosis was performed with 6-0PDS under loop magnificent over double J stent. Operation time, leak, fluid collection, rate of ATN, how long we kept Foley in, incidence of stricture, length of stay, graft and patient survival were measured.

Results:

Mean age was 48.9±13 years, mean operation time was 166.3±41 minutes, estimated blood loss was less than 100ml, leak rate was 0.04( 1 patient) , Foley catheter was kept for 3.3±2.1 days, length of stay was 5.6±1.9 days. With this short follow up no strictures have been detected, and the graft and patient survival was 100%.

Discussion:

Primary Uretero-urterostomy can be performed in all patients except in patients with reflux. We usually place allograft upside down to create a smooth curve between allograft ureter and native ureter. By doing minimal dissection of ureter at the area where ureter crosses the common iliac artery and doing end to side anastomosis we decrease incidence of ischemic stricture at the site of anastomosis. This anastomosis is easy and cuts the operation time. All dissections around bladder is avoided hence zero incidence of leak from bladder anastomosis. Foley can be removed as soon as patient wakes up from anesthesia. Frequency of reflux will be less and difficulty of cannulation of ureter will be avoided if it becomes necessary. We have proven the safety of this approach and to show the superiority of this technique a randomized controlled trial is planned.

Conclusion:

Primary uretero-ureterostomy in renal transplant is a safe procedure and is an alternative to Uretero-neocystostomy.

CITATION INFORMATION: Shokouh-Amiri H, Zibari G, Ahmadzadeh S, Poudel R, Aultman D, Samant H, Singh N. Primary Urtero- Ureterostomy in Renal Transplant, an Old Forgotten but Promising Technique. Am J Transplant. 2017;17 (suppl 3).

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